How to support fathers of preterm infants in early parenthood - An integrative review.

PROBLEM: Preterm birth is a stressful event. Paternal experiences of having a preterm infant indicate a need for tailored support. However, it is unclear which interventions work best. This review presents the evidence on existing healthcare interventions to support fathers of preterm infants in early parenthood, how effective they are and paternal experiences with the interventions. ELIGIBILITY CRITERIA: The integrative review process of Whittemore and Knafl was used to guide the study. A structured and comprehensive literature search was conducted in PubMed (MEDLINE), Embase, CINAHL, PsycInfo, Cochrane, Scopus, Web of Science, SweMed+, and Proquest Dissertation & Thesis Global. SAMPLE: A total of 18 qualitative and quantitative studies were included in the review. The Mixed Methods Appraisal Tool was used to assess quality. RESULTS: Three overall themes were identified in the analysis: 1) Skin-to-skin contact supported interaction between infant and father, 2) information impacted paternal experiences of stress, anxiety, and development of fatherhood, 3) fathers' relationships with the nurses oscillated between conflict and assistance. CONCLUSIONS: Our findings show that targeted interventions could support father-infant interaction and reduce stress among fathers of preterm infants. IMPLICATIONS: Fathers of preterm infants rely on nurses to support their engagement in early parenthood, while nurses facilitate the interventions that engage the fathers. It is also essential to develop a culture within the neonatal intensive care unit that encourages the presence of fathers and enhances educational nursing strategies for supporting fathers of preterm infants during early parenthood.

Engaging in partnerships is the key to preserving and creating a trustful collaboration with vulnerable families: A focus group study.

OBJECTIVE: Maternal vulnerability challenges parenthood and represents a critical task for health professionals working in postnatal care. Being born to a vulnerable mother may have wide-ranging effects on child development and carry the risks of impairment in cognitive performance, behavioural disturbances and mental problems which may persist into late childhood and adolescence. It is vital to explore the perspectives of healthcare professionals who have experience of caring for vulnerable families at the obstetric department and in the transition to the primary healthcare sector to identify and describe potential barriers, challenges and the potential for any improvements in postnatal care. The aim of this study was to describe healthcare professionals' experience of vulnerable families and their extended stay at the obstetric department, and to describe the collaboration between the primary and the secondary healthcare sectors concerning postnatal care. DESIGN AND SETTING: A qualitative inductive descriptive design with focus group interviews was used for data collection. Two two-hour focus group interviews were conducted at a university hospital in the Capital Region of Denmark in February 2019. PARTICIPANTS AND RESULTS: In total, 16 health professionals from the obstetric department and primary healthcare sectors participated. The overall theme found was Engaging in partnership across sectors and with families can improve postnatal care for vulnerable families. It emerged from three categories: 1) vulnerability as an individual perception, 2) communication and trust as essential competencies and 3) collaboration in a partnership. CONCLUSION AND IMPLICATIONS FOR PRACTICE: This study demonstrates the complexity and challenges of postnatal care provided to vulnerable families. It highlights the possibilities and benefits of engaging in partnership across sectors and families to improve postnatal care for vulnerable families. Engaging in partnerships improves the quality of the extended stay at the obstetric department and the transition to the primary healthcare sector.

What are the effects of supporting early parenting by newborn behavioral observations (NBO)? A cluster randomised trial.

BACKGROUND: Professional support to enhance the early parent-infant relationship in the first months after birth is recommended, but little is known about the effect of universal interventions. The objective was to investigate the effect of health visitors' use of the Newborn Behavioral Observations system in new families. METHODS: A cluster-randomised study was conducted in four Danish municipalities. Health visitors' geographical districts constituted the units for randomisation (n = 17). In the intervention group, 1332 families received NBO from 3 weeks after birth; in the comparison group, 1234 received usual care. Self-administered questionnaires were collected at baseline one to two weeks after birth, and at follow-up three and nine months postpartum. The outcomes were change over time measured by The Karitane Parenting Confidence Scale (KPCS), The Major Depression Inventory (MDI), The Ages and Stages Questionnaire: social-emotional (ASQ:SE) and The Mother and Baby Interaction Scale (MABIC). Data were analysed with mixed-effects linear regression using the intention-to-treat approach. RESULTS: At baseline, no significant differences between the two groups were seen regarding maternal and infant factors. At follow-up three and nine months after birth, the change in maternal confidence and mood, infant's socio-emotional behaviour, and early parent-infant relationship moved in a slightly more positive direction in the intervention group than in the comparison group, though not statistically significant. The only significant effect was that the intervention mothers reported higher level of knowledge about infant's communication skills, response to cues, and how to sooth and establish a relation with the infant, compared to the comparison group. CONCLUSIONS: We found no effect of the NBO system delivered in a universal context to all families in a community setting. The only significant difference between groups was a higher maternal degree of knowledge regarding early parenting in the intervention group. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03070652 . Registrated February 22, 2017.

Maternal confidence after birth in at-risk and not-at-risk mothers: internal and external validity of the Danish version of the Karitane Parenting Confidence Scale (KPCS).

BACKGROUND: Parenting confidence is a key factor in predicting a range of outcomes for both parents and children, such as parental depression, parental stress, and child health development. This study examines maternal confidence in at-risk and not-at-risk mothers and the psychometric properties of the Karitane Parenting Confidence Scale (KPCS). RESULTS: The total sample consisted of 695 mothers (488 not-at-risk and 207 at-risk) from a community setting. Cronbach's alpha ranged from 0.72 to 0.79, and item-rest correlations ranged from 0.17 to 0.57. Total score improved significantly from 41.75 at two months to 42.41 at six months for the not-at-risk group and increased significantly from 39.51 at two months to 41.12 at six months for the at-risk group. The differences between the two risk groups were significant at both times. CONCLUSION: The KPCS has acceptable internal consistency, but an overall ceiling effect, with many items characterized by low discrimination. Despite a significant difference in maternal confidence between at-risk and not-at-risk mothers at both two and six months, the total score did not predict risk status very well in this sample. A nine-item version may be equal to the original 15-item version.

Psychometric properties of the Danish Parental Stress Scale: Rasch analysis in a sample of mothers with infants.

The Parental Stress Scale (PSS) was developed as a short measure of perceived stress resulting from being a parent. The current study examined the psychometric properties of the Danish version in a sample of 1110 mothers of children aged 0 to 12 months using Rasch models. Emphasis was placed on the issues of uni-dimensionality and absence of differential item functioning relative to the age and educational level of the mothers. Results showed that no adequate fit could be established for the full PSS scale with 18 dichotomized items. Further analyses showed that items 2 and 11 had to be eliminated from the scale, and that the remaining items did not make up a unidimensional PSS scale, but two subscales measuring different aspect of parental stress: a 9-item scale measuring parental stress and a 7-item scale measuring lack of parental satisfaction. Fit to the Rasch model could not be established for any of the two subscales. For the parental stress subscale, we found evidence of local dependence for four item pairs (3 and 4, 9 and 10, 10 and 16, 12 and 16), as well as evidence of two items functioning differentially: item 16 relative to level of education, and item 3 relative to both age and educational level. For the lack of parental satisfaction subscale, we found evidence of local dependence between some two pairs (1 and 17, 17 and 18), but no evidence of differential item functioning. Both subscales fit graphical loglinear Rasch models adjusting for local dependence and differential item functioning. Plotting the adjusted subscale scores against one another showed that the two-scale solution provides additional information, as some mothers are stressed but not lacking in parental satisfaction.

First-time mothers' confidence mood and stress in the first months postpartum. A cohort study.

OBJECTIVES: The aims were to describe first-time mothers' confidence, mood and stress 2 and 6 months postpartum and to investigate the extent to which the tools measuring maternal confidence and maternal mood used alone or together at 2 months postpartum predict first-time maternal confidence, mood and stress 6 months postpartum. DESIGN: A cohort including 513 first-time mothers' self-reported questionnaires concerning three scales: The Karitane Parenting Confidence Scale (KPCS), the Edinburgh Postnatal Depression Scale (EPDS), and the Parental Stress Scale (PSS) collected 2 and 6 months postpartum. Descriptive statistic, simple and multiple linear regression analysis were used. RESULTS: First-time mothers' with confidence scores below the clinical cut-off (KPCS <40) fell significantly from 25% to 14% (p < 0.001), symptoms of depression above the clinical cut-off (EPDS ≥ 8) fell significantly from 16% to 12% (p < 0.001), and parental stress as a mother fell significantly from a mean of 32.88 to 30.98 (p < 0.001). The KPCS assessed at 2 months postpartum was the strongest predictor for both maternal confidence (R2 = 0.38) and parental stress (R2 = 0.26) 6 months postpartum. CONCLUSION: The results support the assumption that parenthood is a complicated period for first-time mothers characterised by low confidence, symptoms of depression and high stress which improve over time for the majority of mothers. The KPCS at 2 months postpartum was the strongest predictor of the measures used. Further research is needed to identify parents who are struggling, especially for health professionals' whose role is to support parents in their parenthood the first period after birth.

What are the effects of supporting early parenting by enhancing parents' understanding of the infant? Study protocol for a cluster-randomized community-based trial of the Newborn Behavioral Observation (NBO) method.

BACKGROUND: Support to strengthen the early parent-infant relationship is recommended to ensure the infant's future health and development. Little is known about the universal approaches taken by health visitor to support this early relationship. The aim of this study is to investigate the effects of health visitors' use of the Newborn Behavioral Observation (NBO) method among new parents. METHODS: This is a cluster-randomised community-based study implemented in four Danish municipalities. Health visitors will conduct the trial, and the geographical districts they work in will constitute the clusters as units of randomisation. The participants will be approximately 2800 new families, randomised into an intervention or a comparison group according to their health visitor. The families are recruited at the first postpartum home visit. Parents in both groups receive care as usual: parents in the intervention group also receive the standardised NBO method in home visits performed from 3 weeks to 3 months postpartum. Data consist of self-reported parent questionnaires and video recordings of a selected group of vulnerable first-time mothers recorded 4 months postpartum. The self-reported data are obtained: at baseline 1 week postpartum and then at follow-up 3, 9 and 18 months postpartum. Data will be analysed using the intention-to-treat method and the analyses will include comparison of change in the primary variables across time supplemented by multiple regression analysis. The primary study outcomes are measured by the following factors: parental confidence, infants' socio-emotional development and mother-infant relationship. Other measures include parental mood and stress, breastfeeding duration and utility of the health visitor services. Data collection among the health visitors in both groups will serve to monitor any change in practice regarding the work with early parent-infant interactions. DISCUSSION: This protocol describes an evaluation of the NBO method used universally in health visiting practice. The intervention seeks to support early parenting by increasing parents' understanding of their infants' cues. The NBO is currently implemented in Denmark even though an evaluation of the NBO has yet to be made in a community setting in Denmark and internationally. The study may contribute to building an increasingly evidence-based practice for health visitors. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03070652 . Registered February 22, 2017.

Video feedback promotes relations between infants and vulnerable first-time mothers: a quasi-experimental study.

BACKGROUND: Supporting early mother-infant relationships to ensure infants' future health has been recommended. The aim of this study was to investigate whether video feedback using the Marte Meo method promotes a healthy early relationship between infants and vulnerable first-time mothers. Video feedback or usual care was delivered by health visitors during home visits in Danish municipalities. METHODS: This quasi-experimental study included pre- and post-tests of 278 vulnerable families. Mothers were allocated to an intervention group (n = 69), a comparison group (n = 209) and an exactly matched video subsample from the comparison group (n = 63). Data consisted of self-reported questionnaires and video recordings of mother-infant interactions. Outcomes were mother-infant dyadic synchrony (CARE-Index), maternal confidence (KPCS), parental stress (PSS), maternal mood (EPDS) and infant socialemotional behaviours (ASQ:SE). The data were analysed using descriptive and linear multiple regression analysis. RESULTS: The levels of dyadic synchrony in the intervention group had significantly improved (p < 0.001) at follow-up with a mean score of 9.51 (95%CI;8.93-10.09) compared with 7.62 (95%CI;7.03-8.21). The intervention group also showed a higher level of maternal sensitivity with a mean score of 9.55 (95%CI;8.96-10.14) compared with 7.83 (95%CI;7.19-8.46) in the matched video subsample (p < 0.001). With respect to infant cooperation, similar improvements were found with a mean score of 9.43 (95% CI;8.88-9.99) in the intervention group compared with 7.73 (95%CI;7.13-8.33) in the matched video subsample from the comparison group (p < 0.001). Furthermore, mothers in the intervention group reported significantly lower levels of parental stress with a mean score of 32.04 (95%CI;30.13-33.94) compared with 35.29 (95%CI;34.07-36.52) in the comparison group (p = 0.03), as well as higher levels of maternal confidence with a mean score of 41.10 (95%CI;40.22-41.98) compared with 40.10 (95%CI;39.65-40.56) in the comparison group (p = 0.04). No significant differences were found in EPDS and ASQ:SE. CONCLUSION: The findings support the assumption that video feedback using the Marte Meo method early after birth may strengthen the relationship between infants and vulnerable firsttime mothers as well as improve maternal psychosocial functioning. Further research applying random assignment is needed to strengthen these conclusions; further research is also needed to assess any long term effects of the video feedback intervention using the Marte Meo method. TRIAL REGISTRATION: This study was registered on 24 January 2013 in ClinicalTrials.gov with the identifier: NCT01799447 .