Survey of trend and factors in perinatal maternal fatigue.

Few studies have investigated maternal fatigue, particularly fatigue throughout the duration of pregnancy and the postpartum period. The purpose of this study was to explore changes related to maternal fatigue from pregnancy to postpartum and the factors influencing fatigue. This prospective longitudinal study surveyed 197 pregnant women beyond 24 gestational weeks monthly until one month postpartum. The Multidimensional Assessment of Fatigue scale and one question about fatigue were used. Women at late pregnancy experienced a significant increase in level of fatigue, which remained high after childbirth. Those who were not happy about the pregnancy or were multiparas experienced a higher level of prenatal fatigue than their counterparts. At postpartum, mothers who were unemployed, had no one to help with childcare, or felt that the baby's night-time sleep pattern was a serious problem had a higher level of fatigue. Interventions can be planned and implemented at early pregnancy to reduce the prevalence of fatigue. Encouraging pregnant women to share experiences and thoughts about pregnancy and being a mother is suggested. Further studies that evaluate culturally sensitive instruments for fatigue are needed.

The development and psychometric testing of East Asian Acculturation Scale among Asian immigrant women in Taiwan.

OBJECTIVE: This is a report of development and psychometric testing of the East Asian Acculturation Measure-Chinese version (EAAM-C) scale. DESIGN: An instrument validation design with a cross-sectional survey was conducted. The process was carried in two phases. In Phase 1, Barry's East Asian Acculturation Measure was translated and back translated to evaluate its content, face validity, and feasibility validity. In Phase 2, the 16-item EAAM-C was pilot-tested among 485 female immigrants for test-retest reliability, internal consistency, theoretically-supported construct validity and concurrent validity. RESULTS: The pilot work and the survey results indicated the tools possessed adequate content and face validity. The Cronbach's Alphas for the EAAM-C was 0.72, and 0.76-0.79 for its subscales, and the correlation of test-retest reliability (at 3 weeks) was 0.75. After dropping one item, four theoretically-supported factors which explained 61.82% of the variance were abstracted using exploratory factor analysis: assimilation, integration, separation, and marginalization. Based on the underlying four-factor theoretical structures of the EAAM, the confirmatory factor analysis of the EAAM-C was further examined. The analysis revealed that the four-factor model was an acceptable fit for the data which demonstrated adequate finding in its construct validity. These factors were inter-correlated, and showed statistically significant correlation with the Chinese Health Questionnaire, indicating adequate concurrent validity. CONCLUSIONS: The scale shows acceptable validity and consistency, and suggests that immigrant acculturation is a complex construct. This quick evaluation instrument can be applied to assess clients' acculturation and in further developing certain interventions to improve their health.

Trends of Perinatal Stress, Anxiety, and Depression and Their Prediction on Postpartum Depression.

Perinatal stress, anxiety, and depression impacts not only women but also their child(ren). The purpose of this longitudinal study is to explore trends of stress, anxiety, and depressive symptoms from pregnancy to postpartum and understand predictions of stress and anxiety on postpartum depression. One-hundred-fifty-six women at 23-28 weeks gestation (T1), 147 at 32-36 weeks gestation (T2), 129 at over 36 weeks gestation (T3), and 83 at postpartum (T4) completed study surveys. The Perceived Stress Scale, Center for Epidemiologic Studies Depression scale, and State-Trait Anxiety Inventory were used to measure stress, depressive symptoms, and anxiety. Descriptive statistics, Pearson and Spearman's correlation, and Generalized Estimating Equation were applied to analyze the data. Results showed that levels of anxiety and depressive symptoms increased from 24 weeks gestation to postpartum, whereas stress levels decreased during pregnancy but increased in postpartum. Over half of women experienced anxiety symptoms, especially during late pregnancy and postpartum. Stress, anxiety, and depressive symptoms were inter-correlated. Notably, women at late pregnancy and postpartum were prone to stress, anxiety, and depression. Prenatal anxiety could predict postpartum depressive symptoms. Active assessment and management of stress, anxiety, and depression is needed and should begin from early pregnancy and continue until postpartum.

Development and psychometric testing of the Chinese version of the Resilience Scale for Southeast Asian immigrant women who divorced in Taiwan.

BACKGROUND: Only a few studies exist on the resilience of divorced women. Furthermore, relevant instruments for assessing the resilience of divorced immigrant Southeast Asian women are rare. Accordingly, the aim of this study was to develop and examine a new Resilience Scale-Chinese version (RS-C) that is specific to divorced immigrant Southeast Asian women in Taiwan. METHODS: The study was conducted in two phases. In phase 1, 20 items were used to evaluate face and content validities. In phase 2, a cross-sectional study was conducted. In total, 118 immigrant women participated in this study and were recruited from three nongovernmental organizations providing services for immigrants in Taipei City and Miaoli and Chiayi Counties. Psychometric properties of the instrument (i.e., internal consistency, test-retest reliability, item-to-total correlation, construct validity, and convergent validity) were examined. Significance was set at p < 0.05 for all statistical tests. RESULTS: The final 16-item RS-C resulted in a three-factor model. The three factors, namely personal competence, family identity, and social connections, were an acceptable fit for the data and explained 54.60% of the variance. Cronbach's α of the RS-C was 0.85, and those of its subscales ranged from 0.77 to 0.82. The correlation value of the test-retest reliability was 0.87. The RS-C was significantly associated with the General Self-Efficacy scale and the Chinese Health Questionnaire-12. CONCLUSION: The RS-C is a brief and specific self-report tool for evaluating the resilience of divorced immigrant Southeast Asian women and demonstrated adequate reliability and validity in this study. This RS-C instrument has potential applications in both clinical practice and research with strength-based resiliency interventions. However, additional research on the RS-C is required to further establish its reliability and validity.

Avoidance of environmental tobacco smoke among pregnant Taiwanese women: knowledge, self-efficacy, and behavior.

BACKGROUND: The issue of active and passive cigarette smoking among pregnant women at home has become a major source of debate. The purpose of this study was to explore the knowledge of, self-efficacy with, and behavior toward avoiding environmental tobacco smoke and related factors among pregnant women in Taiwan. METHODS: A cross-sectional research design was used. Women (n = 281) visiting the outpatient antenatal clinics of one regional hospital and two medical centers in Taipei for routine obstetrical care volunteered to fill out questionnaires. RESULTS: Participants on average had little knowledge of this issue and felt less than "very confident" in resisting environmental tobacco smoke and indicated that it was only "usually true" that they practiced avoidance behaviors. The knowledge of, self-efficacy with, and behavior toward avoiding environmental tobacco smoke were all related to both the woman and her partner's educational levels. There were significant differences in mean knowledge, self-efficacy, and avoidance of environmental tobacco smoke scores among different household smoking groups. A multiple regression revealed that overall avoidance of environmental tobacco smoke was positively associated with self-efficacy, with a no-smoking policy at home, and with both a woman and her partner's educational levels. CONCLUSIONS: The high prevalence of subjects suffering from active (6.05%) and passive smoking (58.72%) suggests that clinicians can target interventions designed to increase pregnant women's self-efficacy and to advise them to try to set up their own smoking policy at home.

Perceptions of exercise in obese school-aged children.

BACKGROUND: Although the prevalence of obesity continues to increase worldwide, information related to obese school-aged children's perceptions of exercise remains limited. PURPOSE: This study aimed to explore perceptions of exercise held by obese school-aged children. METHODS: This study used a qualitative research design. Using purposive sampling, 11 obese students who were 11 to 13 years old, currently enrolled at two primary schools, and in the precontemplation stage were recruited from a total population of 1,714 to participate in the study. An interview guide with five open-ended questions was used to guide focus group discussions. Data were analyzed using content analysis to identify significant themes. RESULTS: Six themes emerged from collected data, including (a) positive impressions about doing exercise, (b) recognition of negative effects associated with not doing exercise, (c) feelings of discomfort after exercise, (d) self-ambivalence, (e) false beliefs about exercise, and (f) making excuses for not doing exercise. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Study findings provided information giving a better understanding of exercise perceptions among obese children. Such may be used to assist obese children to increase exercise levels as part of efforts to improve health in this vulnerable population.

Postpartum Taiwanese women: their postpartum depression, social support and health-promoting lifestyle profiles.

BACKGROUND: To reach the Millennium Development Goals, maternal health-promoting behaviours need to be encouraged after childbirth; little is known about the health-promoting behaviour among first-time mothers during their postpartum period. AIM: To examine levels of engagement in health-promoting behaviours and related factors among postpartum women in Taiwan. METHODS: This cross-sectional study was conducted through a convenience sample of 122 qualified women. Participants self-completed a questionnaire and mailed it back using a stamped, self-addressed envelope from July to September 2003. Instruments of this study included a demographic questionnaire as well as three Likert-type scales: the Health Promotion Lifestyle Profile scale, the Edinburgh Postnatal Depression scale and a self-developed social support scale. RESULTS: The average overall Health Promotion Lifestyle Profile score was low (mean, 2.83 SD 1.35), with exercise rated lowest among the six subscales. Postpartum women perceived that they had high levels of social support from their mothers-in-law, mothers and husbands. An astonishing 42.6% of women experienced postnatal depression. Based on results of multiple regressions, 25% of the variance in health-promoting lifestyle practices was explained by postpartum depression and social support. Social support was found to predict all subscales significantly except exercise. Postpartum depression can significantly predict self-actualization, interpersonal relationships, nutrition and stress management. All modifying factors were excluded from the regression model. CONCLUSIONS: This study validates the theoretical relationships among concepts in the Health Promotion Model. Nursing interventions are recommended which are tailored to enhance women's social support and decrease their depression to promote their pursuit of healthy lifestyles. RELEVANCE TO CLINICAL PRACTICE: This study highlights the implications of social support to nursing practice, especially in Chinese culture which has a strict ritual during a women's postpartum period. Findings of this study provide information and data for service planning and community care to support postpartum care in the communities.