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Wambach KA, Davis AM, Nelson EL, Snow K, Yungmeyer A, Muzzy R, Romero K, Murray M. momHealth: A Feasibility Study of a Multibehavioral Health Intervention for Pregnant and Parenting Adolescent Mothers. Kans J Med 2021; 14:176-181. [PMID: 34262638 PMCID: PMC8274814 DOI: 10.17161/kjm.vol1414738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/07/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction In 2016, 209,809 babies were born to mothers 15 - 19 years of age, for a live birth rate of 20.3 per 1,000 in this age group. Many health issues surround adolescent mothers and their infants, many of which can be addressed through behavioral change. The main purpose of this study was to examine the feasibility, acceptability, usability, and relevance of momHealth, an innovative multiple health behavior change (MHBC) education and support mHealth intervention, focused on breastfeeding, healthy eating and active living, and depression prevention among pregnant and parenting adolescents. We also evaluated the proposed online surveys and physical outcome measures for feasibility and acceptability (burden, time, ease of use). Methods A one-group quasi-experimental longitudinal design was used to examine the intervention components and the breastfeeding, diet/activity, and depression outcome measures. Nine iPad-delivered education modules, text messaging, and virtual individual and group support were provided for 12 weeks, beginning at 32 weeks of pregnancy, with follow-up to three months postpartum. Data on the main behaviors and outcomes were collected at three in-home visits, one telephone call soon after birth, and ten postpartum weekly and biweekly online surveys. Results Although recruitment and attrition presented challenges, six participants enrolled in the study during prenatal clinic visits; all were pregnant with their first child, single, and had a mean age of 17.7 years (SD = 1.4). Intervention participation ranged from 59% to 91% for educational module completion, text message reading, and individual virtual support meetings and three virtual peer support groups were held. Intervention acceptability, relevance, and delivery was supported by reports of clear and relevant content, reasonable time burden, iPad ease of use, and acceptable intervention length. Data collection was reported as convenient and non-burdensome, but the diet recall method and activity monitoring challenged some. Conclusions This was the first MHBC research in adolescent pregnant women designed to improve breastfeeding outcomes, healthy eating/active living, and depression prevention. Findings demonstrated strengths and challenges of the interventions and methods, support feasibility and acceptability of momHealth, and informed the recruitment and intervention protocols of our pilot randomized trial.
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Affiliation(s)
- Karen A Wambach
- School of Nursing, University of Kansas Medical Center, Kansas City, KS
| | - Ann M Davis
- School of Medicine, Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS
| | - Eve Lynn Nelson
- School of Nursing, University of Kansas Medical Center, Kansas City, KS
| | - Kelli Snow
- Children's Mercy Hospital, Kansas City, MO
| | - Annie Yungmeyer
- School of Nursing, University of Kansas Medical Center, Kansas City, KS
| | - Rachel Muzzy
- School of Medicine, Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS
| | - Karman Romero
- School of Nursing, University of Kansas Medical Center, Kansas City, KS
| | - Megan Murray
- School of Medicine, Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS
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Cluxton-Keller F, Buteau J, Williams M, Stolte P, Monroe-Cassel M, Bruce ML. Engaging rural young mothers in a technology-based intervention for depression. CHILD & YOUTH SERVICES 2019; 40:158-183. [PMID: 31274940 PMCID: PMC6608730 DOI: 10.1080/0145935x.2018.1561264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Peripartum depression is prevalent among young mothers (ages 25 and younger), and low family support can exacerbate depressive symptoms. The current study explores an innovative method for engaging young mothers in a family-based intervention to help reduce peripartum depressive symptoms. This descriptive study includes details on the baseline characteristics of participants, integrative support teams, and a service delivery method to engage families living rural communities. In conclusion, engaging depressed young mothers living in rural communities requires a multifaceted approach. Our approach has demonstrated promise in engaging this hard-to-reach population. Implications for clinical practice and future research are addressed.
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Affiliation(s)
- Fallon Cluxton-Keller
- Department of Psychiatry, Dartmouth College, Geisel School of Medicine, Lebanon, NH, USA
| | | | | | | | | | - Martha L. Bruce
- Department of Psychiatry, Dartmouth College, Geisel School of Medicine, Lebanon, NH, USA
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Wise NJ, Cantrell MA. Effectiveness of recruitment and retention strategies in a pregnant adolescent nutrition intervention study. J Adv Nurs 2018; 75:215-223. [PMID: 30187537 DOI: 10.1111/jan.13840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/10/2018] [Accepted: 07/18/2018] [Indexed: 11/27/2022]
Abstract
AIM To report the methodological strategies used to recruit and retain pregnant adolescents into a nutrition-focused intervention study. BACKGROUND An important step to meeting the developmental and healthcare needs of pregnant adolescents is to conduct high-quality research studies that generate reliable and accurate data. However, recruitment and retention of pregnant adolescents into research are challenging and time intensive. DESIGN A quasi-experimental, one-group, pre, post, 6-week postintervention repeated measures study was conducted among inner-city pregnant adolescents. METHOD Study participants' nutrition knowledge, eating habits, and personal self-efficacy were measured prior to pregnant adolescents' participation in the workshop, immediately after the intervention and 6-weeks following the intervention. A total of four workshops were conducted over 14 months from 2014-2015. RESULTS Gatekeepers were influential in recruitment efforts due to trusting relationship they had with study participants. The use of texting reminders and pregnant adolescent-related incentives that included gift bags and baby items were also effective recruitment and retention strategies. Despite designing the recruitment strategies and using a developmentally tailored workshop, based on empirical evidence gleaned from pregnant adolescents that was modified to meet study participant's schedules, an adequate sample was unable to be recruited and retained for this study. CONCLUSION High-quality research studies that generate reliable and accurate data are essential in meeting the developmental and healthcare needs of pregnant adolescents. A major barrier in developing evidence-based care practices to promote the health of these young mothers and their children involves recruiting and retaining them in research studies.
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Affiliation(s)
- Nancy J Wise
- Eastern Mennonite University, Lancaster, Pennsylvania
| | - Mary Ann Cantrell
- M. Louise Fitzpatrick, College of Nursing, Villanova University, Villanova, Pennsylvania
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SmithBattle L, Lorenz R, Reangsing C, Palmer JL, Pitroff G. A methodological review of qualitative longitudinal research in nursing. Nurs Inq 2018; 25:e12248. [DOI: 10.1111/nin.12248] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Lee SmithBattle
- School of Nursing; Saint Louis University; St. Louis Missouri
| | - Rebecca Lorenz
- UB School of Nursing; University at Buffalo; Buffalo New York
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Nolan S, Hendricks J, Williamson M, Ferguson S. Using narrative inquiry to listen to the voices of adolescent mothers in relation to their use of social networking sites (SNS). J Adv Nurs 2017; 74:743-751. [PMID: 28910502 DOI: 10.1111/jan.13458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 07/27/2017] [Accepted: 08/15/2017] [Indexed: 12/13/2022]
Abstract
AIM This article presents a discussion highlighting the relevance and strengths of using narrative inquiry to explore experiences of social networking site (SNS) use by adolescent mothers. BACKGROUND Narrative inquiry as a method reveals truths about holistic human experience. Knowledge gleaned from personal narratives informs nursing knowledge and clinical practice. This approach gives voice to adolescent mothers in relation to their experiences with SNS as a means of providing social support. DESIGN Discussion paper. DATA SOURCES This paper draws and reflects on the author's experiences using narrative inquiry and is supported by literature and theory. The following databases were searched: CINAHL, Cochrane Library, Medline, Scopus, ERIC, ProQuest, PsychINFO, Web of Science and Health Collection (Informit). Key terms and Boolean search operators were used to broaden the search criteria. Search terms included: adolescent mother, teenage mother, "social networking sites", online, social media, Facebook, social support, social capital and information. Dates for the search were limited to January 1995-June 2017. IMPLICATIONS FOR PRACTICE/RESEARCH Narrative research inherently values the individual "story" of experience. This approach facilitates rapport building and methodological flexibility with an often difficult to engage sample group, adolescents. CONCLUSION Narrative inquiry reveals a deep level of insight into social networking site use by adolescent mothers. The flexibility afforded by use of a narrative approach allows for fluidity and reflexivity in the research process.
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Affiliation(s)
- Samantha Nolan
- School of Nursing, Midwifery & Social Sciences, CQ University, Brisbane, QLD, Australia
| | - Joyce Hendricks
- School of Nursing, Midwifery & Social Sciences, CQ University, Brisbane, QLD, Australia
| | - Moira Williamson
- School of Nursing, Midwifery & Social Sciences, CQ University, Brisbane, QLD, Australia
| | - Sally Ferguson
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
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Bledsoe SE, Rizo CF, Wike TL, Killian-Farrell C, Wessel J, Bellows AMO, Doernberg A. Pregnant adolescent women's perceptions of depression and psychiatric services in the United States. Women Birth 2017; 30:e248-e257. [PMID: 28330583 PMCID: PMC5599310 DOI: 10.1016/j.wombi.2017.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 01/30/2017] [Accepted: 02/11/2017] [Indexed: 10/19/2022]
Abstract
PROBLEM Adolescent mothers and their children are at high-risk for depression and the associated negative educational, social, health, and economic outcomes. BACKGROUND However, few pregnant adolescent women with depression receive psychiatric services, especially low-income or racial/ethnic minority adolescent women. AIM This qualitative study explores perceptions of depression, psychiatric services, and barriers to accessing services in a sample of low-income, pregnant racial/ethnic minority adolescent women. Our goal was to better understand the experiences of depression during pregnancy for these vulnerable adolescent women, and thereby improve their engagement and retention in services for perinatal depression. METHODS We recruited 20 pregnant adolescent women who screened positive for depression from 2 public health prenatal clinics in the southeastern United States. Participants were low-income and primarily racial/ethnic minority women between 14 and 20 years old. Data were collected through individual in-depth, ethnographically informed interviews. FINDINGS Generally, participants lacked experience with psychiatric services and did not recognize their symptoms as depression. However, participants perceived a need for mood improvement and were interested in engaging in services that incorporated their perspective and openly addressed stigma. DISCUSSION Participants reported practical and psychological barriers to service engagement, but identified few cultural barriers. Family perceptions of psychiatric services served as both a barrier and support. CONCLUSION Adolescent women are more likely to engage in psychiatric services if those services reduce practical and psychological barriers, promise relief from the symptoms perceived as most meaningful, and address underlying causes of depression. Culture may affect Latina adolescent women's perceptions of depression and services.
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Affiliation(s)
- Sarah E Bledsoe
- University of North Carolina at Chapel Hill, School of Social Work, 325 Pittsboro Street, Chapel Hill, NC 27599-3550, USA.
| | - Cynthia F Rizo
- University of North Carolina at Chapel Hill, School of Social Work, 325 Pittsboro Street, Chapel Hill, NC 27599-3550, USA
| | - Traci L Wike
- School of Social Work, Virginia Commonwealth University, 1001 West Franklin Street, Richmond, VA 23284-2027, USA
| | - Candace Killian-Farrell
- University of North Carolina at Chapel Hill, School of Social Work, 325 Pittsboro Street, Chapel Hill, NC 27599-3550, USA
| | - Julia Wessel
- University of North Carolina at Chapel Hill, School of Social Work, 325 Pittsboro Street, Chapel Hill, NC 27599-3550, USA
| | - Anne-Marie O Bellows
- University of North Carolina at Chapel Hill, School of Social Work, 325 Pittsboro Street, Chapel Hill, NC 27599-3550, USA
| | - Alison Doernberg
- University of North Carolina at Chapel Hill, School of Social Work, 325 Pittsboro Street, Chapel Hill, NC 27599-3550, USA
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Ngabireyimana E, Mutaganzwa C, Kirk CM, Miller AC, Wilson K, Dushimimana E, Bigirumwami O, Mukakabano ES, Nkikabahizi F, Magge H. A retrospective review of the Pediatric Development Clinic implementation: a model to improve medical, nutritional and developmental outcomes of at-risk under-five children in rural Rwanda. Matern Health Neonatol Perinatol 2017; 3:13. [PMID: 28706729 PMCID: PMC5506624 DOI: 10.1186/s40748-017-0052-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/07/2017] [Indexed: 11/12/2022] Open
Abstract
Background As more high-risk newborns survive the neonatal period, they remain at significant medical, nutritional, and developmental risk. However, no follow-up system for early intervention exists in most developing countries. In 2014, a novel Pediatric Development Clinic (PDC) was implemented to provide comprehensive follow-up to at-risk under-five children, led by nurses and social workers in a district hospital and surrounding health centers in rural Rwanda. Methods At each PDC visit, children undergo clinical/nutritional assessment and caregivers participate in counseling sessions. Social assessments identify families needing additional social support. Developmental assessment is completed using Ages and Stages Questionnaires. A retrospective medical record review was conducted to evaluate the first 24 months of PDC implementation for patients enrolled between April 2014–December 2015 in rural Rwanda. Demographic and clinical characteristics of patients and their caregivers were described using frequencies and proportions. Completion of different core components of PDC visits were compared overtime using Fisher’s Exact test and p-values calculated using trend analysis. Results 426 patients enrolled at 5 PDC sites. 54% were female, 44% were neonates and 35% were under 6 months at enrollment. Most frequent referral reasons were prematurity/low birth weight (63%) and hypoxic-ischemic encephalopathy (34%). In 24 months, 2787 PDC visits were conducted. Nurses consistently completed anthropometric measurements (age, weight, height) at all visits. Some visit components were inconsistently recorded, including adjusted age (p = 0.003), interval growth, danger sign assessment, and feeding difficulties (p < 0.001). Completion of other visit components, such as child development counseling and play/stimulation activities, were low but improved with time (p < 0.001). Conclusions It is feasible to implement PDCs with non-specialized providers in rural settings as we were able to enroll a diverse group of high-risk infants. We are seeing an improvement in services offered at PDCs over time and continuous quality improvement efforts are underway to strengthen current gaps. Future studies looking at the outcomes of the children benefiting from the PDC program are underway.
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Affiliation(s)
| | - Christine Mutaganzwa
- Department of Pediatrics, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.,P.O. Box 3432, Kigali, Rwanda
| | - Catherine M Kirk
- Department of Pediatrics, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | - Ann C Miller
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, USA
| | - Kim Wilson
- Division of General Pediatrics, Boston Children's Hospital, Boston, USA.,Harvard Medical School, Department of Global Health and Social Medicine, Boston, USA
| | | | | | | | | | - Hema Magge
- Department of Pediatrics, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA.,Division of General Pediatrics, Boston Children's Hospital, Boston, USA
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An umbrella review of meta-analyses of interventions to improve maternal outcomes for teen mothers. J Adolesc 2017; 59:97-111. [PMID: 28601024 DOI: 10.1016/j.adolescence.2017.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 01/12/2017] [Accepted: 05/29/2017] [Indexed: 01/08/2023]
Abstract
The purpose of this study was to perform an umbrella review of meta-analyses of intervention studies designed to improve outcomes of pregnant or parenting teenagers. An extensive search retrieved nine reports which provided 21 meta-analyses analyses. Data were extracted by two reviewers. Methodological quality was assessed using the AMSTAR Instrument. Most effect sizes were small but high quality studies showed significant outcomes for reduced low birth weight (RR = 0.60), repeat pregnancies/births (OR = 0.47-0.62), maternal education (OR = 1.21-1.83), and maternal employment (OR = 1.26). Several parenting outcomes (parent-child teaching interaction post-intervention [SMD = -0.91] and at follow-up [SMD = -1.07], and parent-child relationship post-intervention [SMD = -0.71] and at follow-up [SMD = -0.90]) were significant, but sample sizes were very small. Many reports did not include moderator analyses. Behavioral interventions offer limited resources and occur too late to mitigate the educational and social disparities that precede teen pregnancy. Future intervention research and policies that redress the social determinants of early childbearing are recommended.
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Logsdon MC, Martin VH, Stikes R, Davis D, Ryan L, Yang I, Edward J, Rushton J. Lessons Learned From Adolescent Mothers: Advice on Recruitment. J Nurs Scholarsh 2015; 47:294-9. [PMID: 25968179 DOI: 10.1111/jnu.12142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 01/15/2023]
Abstract
PURPOSE Adolescent mothers have high rates of depressive symptoms and inadequate rates of depression evaluation and treatment. The purpose of this qualitative study was to identify characteristics of effective recruitment ads for an Internet-based depression intervention for pregnant and parenting adolescents. METHODS Using focus group methods, participants (N = 35) were recruited and enrolled at a teen parent program, part of the public school system. Focus group sessions were analyzed for participant preferences, rationale for choices, key words, and the frequency of words within the videotapes and audiotapes. RESULTS Findings indicated that adolescent mothers preferred pictures in which everyone looked happy, narrative that clearly indicated cost and eligibility, and words that they would use in conversation. CLINICAL RELEVANCE The study filled an important gap in the literature by soliciting from pregnant and parenting adolescents their preferences regarding visual appeal, content adequacy, and message clarity of advertisements that would motivate them to visit an Internet intervention for depression. Results could be extrapolated to education of pregnant and parenting adolescents in clinical settings.
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Affiliation(s)
- M Cynthia Logsdon
- Professor, School of Nursing, University of Louisville, and Associate Chief of Nursing for Research, University of Louisville Hospital, Kentucky One Health, Louisville, KY, USA
| | - Vicki Hines Martin
- Professor, School of Nursing, University of Louisville, Louisville, KY, USA
| | - Reetta Stikes
- Professor, Department of Pediatrics, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Deborah Davis
- Advanced Practice Educator, University of Louisville Hospital, Kentucky One Health, Louisville, KY, USA
| | - Lesa Ryan
- Research Assistant, School of Nursing, University of Louisville, Louisville, KY, USA
| | - Iren Yang
- Postdoctoral Fellow, Nell Hodgson Woodruff School of Nursing School of Nursing, Emory University, Atlanta, GA, USA
| | - Jean Edward
- Assistant Professor, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Jeff Rushton
- Director of Digital Media, University of Louisville, Louisville, KY, USA
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Madigan S, Vaillancourt K, McKibbon A, Benoit D. Trauma and traumatic loss in pregnant adolescents: the impact of Trauma-Focused Cognitive Behavior Therapy on maternal unresolved states of mind and Posttraumatic Stress Disorder. Attach Hum Dev 2015; 17:175-98. [PMID: 25703488 DOI: 10.1080/14616734.2015.1006386] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pregnant adolescents are a group at high risk for exposure to traumatic experiences. The present study aimed to examine if Trauma-Focused Cognitive Behavior Therapy (TF-CBT) typically applied to Posttraumatic Stress Disorder (PTSD), could also be applied to unresolved states of mind in a sample of socially at-risk pregnant adolescents. Forty-three adolescents who were in their second trimester of pregnancy and who also had positive indices of unresolved states of mind or symptoms of PTSD were randomly assigned to either the treatment as usual (parenting classes) or intervention (parenting classes + TF-CBT) group. Adolescent mother-infant dyads were then re-assessed at infant ages 6 and 12 months on a broad range of measures, including those specific to attachment, as well as to PTSD, and adolescent behavioral adjustment. Twenty-six of the 43 (60%) recruited subjects completed all components of the study protocol. Although there were no significant effects of the TF-CBT intervention on maternal attachment, infant attachment, PTSD diagnosis and adolescent behavioral adjustment, several study limitations restrict our ability to draw firm conclusions about the efficacy of TF-CBT for use in pregnant adolescents with complex trauma. The discussion offers insight and guidance for clinical work and future intervention research efforts with this vulnerable population.
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