Psychometric testing of the Chinese version of the Perceived Maternal Parenting Self-Efficacy Scale among postpartum women.

BACKGROUND: Maternal parenting self-efficacy plays a critical role in facilitating positive parenting practices and successful adaption to motherhood. The Perceived Maternal Parenting Self-Efficacy Scale (PMPS-E), as a task-specific measure, confirms its psychometric properties in cultural contexts. Compared with other tools, the advantages of the PMPS-E are as follows: (i) specific context or time period during the lifespan of a child, (ii) explicitly assess parenting self-efficacy across a diverse enough range of parenting tasks or activities during the perinatal/postnatal period and (iii) having robust psychometric properties. The aim of this study was to translate and determine the psychometric properties of the PMPS-E among Chinese postpartum women (C-PMPS-E). METHOD: The cross-cultural adaptation process followed Beaton et al.'s intercultural debugging guidelines. A total of 471 women were included to establish the psychometric properties of the C-PMPS-E. Mothers were asked to complete the C-PMPS-E, Edinburgh Postnatal Depression Scale (EPDS), the Generalized Anxiety Disorder-7 (GAD-7) and several demographic questions. The psychometric testing of the C-PMPS-E was established through item analysis, construct validity and internal consistency reliability. RESULTS: Item analysis showed that the critical ratios of all items were greater than 3 between the low-score group and high-score group, and all item-total correlation coefficients were greater than 0.4. The fit indices showed that the original correlated four-factor model of C-PMPS-E was observed to be an excellent fit to the data. The PMPS-E was negatively correlated with the EPDS and GAD-7 demonstrating its discriminant validity. As expected, no significant correlation was found between PMPS-E total or subscale scores and mothers' age. In addition, statistically significant differences for parity were detected for C-PMPS-E total and subscale scores with multipara having higher scores. This was taken as further evidence of the scale known-groups discriminant validity. In terms of internal consistency, the Cronbach's alpha of the C-PMPS-E total scale was 0.950, and subscales ranged from 0.76 to 0.89. Furthermore, a ROC curve analysis was conducted to establish the ability of the C-PMPS-E to distinguish between symptoms of depression and symptoms of anxiety. A cut-off value of 55 was identified that resulted in good specificity and fair sensitivity. CONCLUSION: The C-PMPS-E is a reliable and valid tool to assess maternal parenting self-efficacy in a Chinese context.

Breastfeeding success and its relation to maternal pain, behaviour, mental health, and social support.

OBJECTIVE: We aimed to understand the maternal experience of breastfeeding onset and how psychological, social and clinical variables as pain during breastfeeding, may interfere with it. METHODS: A cross-sectional study investigated 395 post-delivery women able to breastfeed from 48 hours to 6 days for unpleasant breastfeeding, maternal stress during pregnancy and postnatal mental state. Social Readjustment Rating Scale evaluated prenatal maternal stress. Perceived Maternal Parenting Self-Efficacy Scale, Pain Catastrophizing Scale - Parent version, and Edinburgh Postnatal Depression Scale evaluated maternal mental state. RESULTS: Unpleasant breastfeeding experience showed to be positively related to the longer number of days the pain lasts; late onset of breastfeeding; less search for information about pregnancy and baby care (p < .01); lower catastrophizing behaviour towards infant´s stress and C-section delivery (p < .04). Pain levels were positively correlated to longer periods of pain, later onset of antenatal consultations and depression (p < .05). Binary logistic regression pointed to the effects of lower self-efficacy and pain in breastfeeding, higher depression levels, gestational stress, labour adversities and success in breastfeeding. CONCLUSIONS: The relationship among maternal perceived self-efficacy, anxious and depressive thoughts, catastrophizing behaviours, and unpleasant breastfeeding need to be evaluated to elucidate the best health professional intervention.

Neurobehavioral assessment predicts differential outcome between VLBW and ELBW preterm infants.

OBJECTIVE: To evaluate the impact of birth weight on development of very low birth weight (VLBW) infants using the Neurobehavioral Assessment of the Preterm Infant (NAPI) before hospital discharge, and to show the relation to follow-up outcomes at 12, 18 and 30 months of age. STUDY DESIGN: In total, 113 preterm infants were assessed with the NAPI at 36 weeks postmenstrual age. Later, neurodevelopment was examined using the Bayley Infant Neurodevelopmental Screener (BINS) at 12 months and the Bayley Scales of Infant Development, at 18 and 30 months. The cohort was divided into two groups, based on birth weight, extremely low birth weight (ELBW) (<1000 g) and VLBW (1000 to 1500 g). RESULTS: ELBW infants showed significantly lower NAPI scores compared with VLBW infants at 36 weeks. The predischarge NAPI scores correlated with the 12, 18 and 30 months scores when the ELBW infants continue to have lower performance than the VLBW infants. In all, 14 infants developed cerebral palsy. These infants had significantly lower NAPI, BINS and Bayley scores compared with all other preterm infants. CONCLUSION: NAPI before discharge provides clinically meaningful information related to later neurodevelopmental outcome.

Neonatal Psychoneuroimmunology: Emergence, Scope and Perspectives.

Interdisciplinary Neonatology investigates and cares for at-risk babies, including risk for developmental disabilities. Psychoneuroimmunology seeks to unravel relationships amongst behavioural, neural, endocrine, and immune processes, and their mutual role in maintaining health and treating disease. This article presents an integrative approach to the emergence, scope and perspectives of a new sub-discipline, i.e. Developmental Neonatal Psychoneuroimmunology. The Equilibrium Model (ThEM) proposed by Adamson-Macedo (1991) will be used as a way of representing coactions; within this frame, Gottlieb's experiential canalization (1991b) contributes an explanation of how the psychoneuroimmunological development of the preterm neonate can be facilitated.

Perceived Parenting Self-Efficacy (PMP S-E) of mothers who are breastfeeding hospitalised preterm neonates.

Breastfeeding is a complex task for many mothers but may be particularly difficult when coping with the birth of a preterm. In the following article the task of breastfeeding a preterm neonate is identified as one facet of the parenting process and the many problems encountered when breastfeeding are highlighted. Research is presented which investigates whether breastfeeding a preterm neonate mediates mothers' Perceived Parenting Self-Efficacy (PMP S-E) whilst in hospital. The findings from this study suggest that not only do mothers who are breastfeeding their preterm neonate have a lower self-efficacy than non-breastfeeding mothers, but they also require further support in all aspects of parenting. The authors discuss these results in terms of self-efficacy theory and suggest that they may have implications for Neonatal Health Psychologists practice particularly with regard to the facilitation of breastfeeding within the neonatal unit.

Prematurity and adult minor illness.

The long term impact of being born premature has received limited scientific investigation. Studies that have been carried out, focus on outcomes in childhood, with very few considering the impact on adult physical health. Three case studies are presented here, investigating differences in adult minor illness and psychological variables between adult participants born preterm, fullterm but small and fullterm with normal birthweight. This is a retrospective design using questionnaires and checklist to gather relevant information. Minor illness symptoms, daily hassles, anxiety, depression and general self-efficacy were measured. The participant born preterm scored higher on all measures. Data were applied to the Equilibrium Model for Minor Illness. Being born early appears to have a greater impact on later adult outcomes measured than being born fullterm but small or fullterm but of normal weight. In this article the authors reflect upon possible explanations for the different outcomes of each of the participants within the foetal origins of disease theory.

Maternal-fetal attachment: searching for a new definition.

Maternal-fetal attachment is the purest source of the powerful attachment relationship, the gradual internalisation of the life within unspoilt by the realities and complexities of early parenting. This qualitative study searches for a definition of attachment utilising a phenomenological framework. An opportunity sample of 10 women in the final trimester of pregnancy was interviewed. Interviews were transcribed and analysed using Glaser & Strauss's (1967) constant comparative methodology. Thirteen key themes were identified, of these 4 were specific to parenting experience. A novel finding contrary to earlier studies was that women reported their overwhelming emotion was not love but an innate desire to protect. Protection, the developmental nature of attachment and importance of the emotional and physical support of a partner or parent form the kernel of an evolving paradigm.

Foetal origins theory: links with adult depression and general self-efficacy.

OBJECTIVE: Foetal origins theory has suggested that early environment can affect vulnerability to major diseases in later life. Recent research also suggests that foetal hormonal programming may influence neurotransmitter and hormone levels affecting adult psychological states (i.e. depression and general self-efficacy). However, investigations into early environment and depression have focused on hospitalised or elderly participants, using non-standard measures. This study investigates links between birthweight and depression in a non clinical adult population, as well as links with general self-efficacy and depression. METHODS: This is a retrospective design. 100 participants mean age 25.9 self reported birthweight, current height and weight to allow computation of BMI. A General Self-Efficacy Scale and the Hospital Anxiety and Depression Scale were also completed. The official classification of low birthweight (2.5 kg) and the median weight for the group (3.26 kg) were used to identify three groups. FINDINGS: One way ANOVA showed that variance in depression [F = 5.31, (2,97) p =.006] and lower general self-efficacy [F = 4.04, (2,96) p =.021] is explained by membership of birthweight group. There was no variance between depression and age, although general self-efficacy did increase with age [F = 6.13, (2,95) p =.003). There was no significant variance between BMI and birthweight or depression. DISCUSSION: Findings add to the growing body of research suggesting that foetal environment influences later life, particularly that early programming may affect hormone and neurotransmitter secretions which may influence later life psychological as well as physical health.

The mediating role of cutaneous sensitivity within neonatal psychoneuroimmunology.

Preliminary results of this study have been presented at the ICIS Conferences held in Atlanta, 1998; a Summary of results has been quoted in Adamson-Macedo (1997; 1998). OBJECTIVES: Despite knowledge that preterm infants in intensive care are in distress and need to be provided with appropriate intervention, studies with ventilated babies are still rare particularly during their first weeks of life. This study tested the hypothesis that cutaneous stimulation in the form of TAC-TIC therapy, involving only light stroking and NOT massage or kinesthetic massage, has a mediating role in eliciting beneficial psychoneuroimmunological coactions in the ventilated preterm during the first week of post-natal life. METHODS: A repeated measure, counterbalanced design, was used to collect data twice daily for three consecutive days. This intervention was compared with a control condition consisting of a period of spontaneous activity during which the same infants lay alone with no intervention taking place. For the first time, monitoring facilities were made available for immunological, physiological and behavioral responses to be assessed simultaneously before and after intervention and before and after spontaneous activities. RESULTS. A one tailed t-test indicated that the cutaneous intervention resulted in significantly more episodes of beneficial coactions than matched sessions of spontaneous activity. CONCLUSION: It is suggested that the sensory nerves endings in the skin receive the stimulation from the stroking actions; consequently impulses are being sent via afferent nerve fibers to the limbic system where the sensation is interpreted, by 68% of the neonates, as being comforting or not distressing.

Detection of secretory immunoglobulin A (SIgA) in saliva of ventilated and non-ventilated preterm neonates.

The very young preterm neonate has multiple immune deficiencies which may increase his or her vulnerability to infection. Secretory Immunoglobulin A (SIgA) plays an important role in the protection of epithelial surfaces exposed to the external environment; nevertheless controversy exists with regards to the ontogeny of SIgA in newborns and especially the preterm neonate. The objective was to investigate if SIgA could be detected in the saliva of very/extremely low birthweight neonates (V/ELBW). A total of 707 samples which were collected twice daily (morning and afternoon) for three consecutive days were obtained from sixty-eight preterm neonates (mean gestational age 28 weeks; conceptional age ranged from 25-35 weeks). A repeated measures design was used. Total concentration of SIgA was determined from unstimulated saliva by an Enzyme Linked Immunosorbant Assay technique. Results indicated that SIgA was detectable in the early postnatal period in the saliva of both ventilated preterms who were receiving intravenous total parenteral nutrition (TPN) and non-ventilated preterms. A 3-way repeated measures Analysis of Variance (ANOVA) showed no significant effect from 'before' and 'after' samples during a period of spontaneous activity, time and day of sampling. A significant effect of mode of nutrition was found; neonates who were receiving expressed breast milk had significantly higher concentrations of SIgA than those infants receiving TPN (df=3, F=14.27, p<0.0001). These results have implications for the care of the preterm neonate in intensive care.

Perceived Maternal Parenting Self-Efficacy (PMP S-E) tool: development and validation with mothers of hospitalized preterm neonates.

AIM: This paper is a report of a study to develop and test the psychometric properties of the Perceived Maternal Parenting Self-Efficacy tool. BACKGROUND: Mothers' perceptions of their ability to parent (maternal parenting self-efficacy) is a critical mechanism guiding their interactions with their preterm newborns. A robust measure is needed which can measure mothers' perceptions of their ability to understand and care for their hospitalized preterm neonates as well as being sensitive to the various levels and tasks in parenting. METHODS: Using a mixed sampling methodology (convenience or randomized cluster control trial) 165 relatively healthy and hospitalized mother-preterm infant dyads were recruited in 2003-2005 from two intensive care neonatal units in the United Kingdom (UK). Mothers were recruited within the first 28 days after giving birth to a preterm baby. The Perceived Maternal Parenting Self-Efficacy tool, which is made up of 20 items representing four theorized subscales, was tested for reliability and validity. RESULTS: Internal consistency reliability of the Perceived Maternal Parenting Self-Efficacy tool was 0.91, external/test-retest reliability was 0.96, P<0.01. Divergent validity using the Maternal Self-Report Inventory was r(s)=0.4, P<0.05 and using the Maternal Postnatal Attachment Scale was r(s)=0.31, P<0.01. CONCLUSION: The Perceived Maternal Parenting Self-Efficacy tool is a psychometrically robust, reliable and valid measure of parenting self-efficacy in mothers of relatively healthy hospitalized preterm neonates. Although application outside the UK will require further cross-cultural validation, the tool has the potential to provide healthcare professionals with a reliable method of identifying mothers of preterm hospitalized babies who are in need of further support.