Habit and Routine Interventions with Emerging Adults with Diabetes: An Integrative Review.

Although theoretical and empirical writings on habits and routines are a promising body of science to guide interventions, little is known about such interventions among emerging adults with type 1 diabetes. Thus, an integrative review was conducted to describe interventions in relation to habits and routines, their influence on outcomes, and users' perspectives. A medical librarian conducted a search. Teams screened titles, abstracts, and articles based upon predefined criteria. Evidence from the final 11 articles was synthesized. A minority of investigators explicitly articulated habits and routines theoretical underpinnings as part of the interventions. However, text messaging or feedback via technology used in other interventions could be implicitly linked to habits and routines. For the most part, these interventions positively influenced diabetes self-management-related behaviors and health outcomes. In general, the interventions were perceived positively by users. Future research is advocated using habit and routine theoretical underpinnings to guide interventions.

An Integrative Review of Postpartum Depression in Rural U.S. Communities.

AIM: This study's aim is to synthesize and summarize the literature on postpartum depression (PPD) in U.S. rural populations. BACKGROUND: Internationally, PPD has a high prevalence in rural communities. Although women in rural U.S. communities have higher rates of depression outside of the postpartum time period, little study has been conducted on PPD in U.S. rural populations. It is unknown whether rural women in the United States have high rates of PPD as is common in rural populations internationally. DESIGN: We used integrative literature review using Whittemore and Knafl's (2005) methodology. DATA SOURCES AND METHODS: We searched the databases MEDLINE, CINAHL, PsycINFO, and Academic Search Premier with the words "postpartum depression" or "postnatal depression" and the word "rural." RESULTS: We found 11 articles with empirical data that met the criteria and thus were included in the review. Seven articles were quantitative, two were qualitative, one was mixed methods, and one was a nonexperimental design. Five foci emerged in the literature including (a) screening and prevalence, (b) demographic factors, (c) program creation and implementation, (d) mental health care seeking, and (e) social support. The results suggest that prevalence of PPD may be higher in rural U.S. areas, that implementing PPD prevention and screening programs for rural women is feasible, and that women in rural areas rely on informal networks and may face a stigma for seeking mental health care. CONCLUSIONS: Further research is needed on PPD in rural U.S. POPULATIONS: Specifically, this research should focus on the mix of variables found throughout this review such as race and income level. Nurses should lead for changes in clinical practice and policy that increase screening and interventions for PPD in rural communities.

Social Support and Psychosocial Well-being Among Low-Income, Adolescent, African American, First-Time Mothers.

AIMS: The aims of this study are to describe for single, low-income, adolescent, African American new mothers how (1) primary sources of social support changed over time, (2) the level of social support (emotional, informational, tangible, and problematic) from these primary sources changed over time, and (3) social support from the primary supporter was associated with mothers' psychosocial well-being (self-esteem and loneliness) over time. DESIGN: A secondary analysis was conducted of data from a previous social support intervention study. SAMPLE: The sample consisted of 35 single, low-income, adolescent (mean [SD] age, 18.3 [1.7] years), African American new mothers. METHODS: Mothers completed social support, self-esteem, and loneliness instruments at 1 and 6 weeks and 3 and 6 months postpartum. RESULTS: Most mothers (64.7%) had changes in their primary social support provider during the first 6 months postpartum. The combination of the adolescent's mother and boyfriend provided the highest level of support, no matter the type, relative to any other source of support. At every time point, positive correlations were found between emotional support and self-esteem and between problematic support and loneliness. CONCLUSION: Single, low-income, African American, adolescent new mothers are at risk for not having a consistent source of support, which may lead to lower self-esteem and greater loneliness. IMPLICATIONS: Clinical nurse specialists could facilitate care guidelines for these new mothers to identify their sources of support at each home visit and advocate for the adolescent's mother and boyfriend to work together to provide support. Bolstering the mothers' natural sources of support can potentially improve self-esteem and reduce loneliness. Improvement in these sources of support could prevent a decline in the mothers' psychosocial well-being. Development and testing support interventions are advocated; findings could guide clinical nurse specialists in addressing these new mothers' needs.

Low-Income, African American, Adolescent Mothers' Depressive Symptoms, Perceived Stress, and Social Support.

The purpose of this descriptive repeated-measures study was to describe depressive symptom patterns and report changes over time in levels of perceived stress and social support depending on patterns of depressive symptoms in single, low-income, African American, adolescent mothers during the initial, 6-month postpartum period. Thirty-five adolescent subjects between the ages of 16 and 22 years old were recruited at health care clinics in two Midwestern cities. Data collections by advanced practice nurses were completed at 1 week, 6 weeks, 3 months, and 6 months postpartum at mothers' homes. Established instruments were used to measure depressive symptoms, perceived stress and social support. Results indicated 63% of adolescent mothers' experienced depressive symptoms sometime during this transition period and 11.4% of these subjects had depressive symptoms at all 4 time points. Depressive symptoms were associated with perceived stress at each time point. Emotional support was inversely associated with depressive symptoms at 2 of the 4 time points. Depressive symptoms and problematic support were significantly related at 3 months and 6 months. Although single, low-income, African American, adolescent mothers are considered a high risk group, some are at even greater risk. This extremely high risk group have depressive symptoms throughout the first 6 months postpartum with the highest level of perceived stress and the most variability in social support relative to groups that were never depressed or were in and out of depression. More studies are needed to understand how to best help these high risk adolescents successfully transition to motherhood.

You can't put a dollar amount on presence: young, non-resident, low-income, African American fathers.

AIMS AND OBJECTIVES: The purpose of this transcendental phenomenological study was to describe the lived experiences of young, non-resident, low-income, African-American fathers. METHODS: Semi-structured interviews were conducted with a convenience sample of 6 men enrolled in the Omaha Healthy Start, Fathers for a Lifetime Program. RESULTS: The following themes were identified: (a) A Work in Progress: Fatherhood Investment; (b) A Little Island by Myself: Barriers to Fathering; (c) I'm Going to be There From Day One to Infinity: Presence; and (d) The Tomorrow Dad: Not Like my Dad. Barriers to fathering created resource-poor environments posing challenges to involvement. CONCLUSIONS: Dispelling the myth of the "hit-and-run" father or the "package deal" remains a concern for fathers and their children. Nurses can develop early assessment strategies and interventions to help African American fathers with their parenting involvement. Fathers can be encouraged to attend community-based fathering programs to increase investment opportunities.

Effects of an internet intervention on mothers' psychological, parenting, and health care utilization outcomes.

AIMS AND OBJECTIVES: The purpose of this pilot study was to test the effects of an Internet-based intervention, the New Mothers Network, on single, low-income, adolescent, African American mothers' psychological, parenting, and health care utilization outcomes. BACKGROUND: The study was based on social support theory. METHODS: For mothers in the Intervention Group, MSNTV™ was installed in subjects' homes and connected to the Internet. Data were collected at 1 week, 6 weeks, 3 months, and 6 months following the infant's birth. RESULTS: For infant health services utilization, 70.6% of those in the Control Group took their infant to the emergency room at least once during the study compared to 35.7% of mothers in the Intervention Group. The New Mothers Network allowed mothers to share their experiences and acquire information from nurses about caring for themselves and their infants. CONCLUSION: The New Mothers Network Web site is well poised for nursing driven social support intervention via the Internet, even though access devices are evolving over time.

Mexican American mothers' eating and child feeding behaviors.

OBJECTIVE: The purpose of this study of Mexican-American mothers of 2-6 year old children was to explore the relationships among maternal attitude, perceived behavioral controls, mother's intent, mother's regulation of her own Simple Carbohydrate Intake (SCI), and mother's child feeding behaviors. The overall objective was to increase understanding of the complex process of intention to eat healthy. METHODS: A prospective exploratory design using a convenience sample of a cohort of 82 Mexican-American mothers was used in this study. Structured questionnaires were selected to measure cognitive restraint, disinhibition, hunger, intent to regulate SCI, and mothers' monitoring, restricting, and pressuring of children's diets. Descriptive statistics and correlations were analyzed for each relationship. RESULTS: The relationships between disinhibition, hunger, cognitive restraint, and the intent variable were significant. More than half of these mothers reported limiting soda and candy for themselves. According to the Food Frequency Questionnaire, mothers were regulating only one-third of simple carbohydrate items they intended to regulate. Significant relationships were found between mothers' regulation of her specific SCI and her control of child feeding behaviors including pressuring, monitoring, and restricting. CONCLUSION: The findings support the idea that mother's eating behaviors, attitudes, and intent may affect how they feed their pre-school children. Nurses need to develop and test interventions targeted at educating Mexican-American mothers about healthy food choices and healthy child feeding behaviors.

Online support for single, low-income, African American mothers.

PURPOSE: To enhance understanding of the phenomenon of being a single, low-income, African American mother through their discussions and use of an Internet-based social support intervention. STUDY DESIGN AND METHODS: The New Mothers Network discussion forum was made available to 20 mothers in their homes for 6 months after the infant's birth. Nineteen mothers posted 174 messages to research nurses and to one another. Thematic analysis of the written messages was completed. RESULTS: The following themes emerged from discussion forum comments: (a) dealing with the father of the baby, (b) mourning losses, (c) positive and negative support, (d) financial needs and concerns, (e) career and educational goals, (f) balancing act, (g) trust issues, and (h) tuned in to baby. CLINICAL IMPLICATIONS: The New Mothers Network allowed these African American mothers to share their experiences and assimilate information from nurses about caring for themselves and their infants. Other nurses can create similar Internet discussion forums for the purposes of providing social support to mothers who have access to computers. Computer software for creating discussion forum sites can be purchased at a reasonable cost, and some are available free of charge.

Community leaders' perceptions of Hispanic, single, low-income mothers' needs, concerns, social support, and interactions with health care services.

Hispanic, single, low-income mothers are a vulnerable population who are often identified as having difficult transitioning to motherhood and successfully using the U.S. health care system. The purpose of this study was to examine needs, concerns, and social support of Hispanic, single, low-income mothers during the transition to motherhood through the eyes of community leaders serving this population in the U.S. Two focus groups were conducted, and 16 Midwestern community leaders working or volunteering with the Hispanic population expressed their opinions. Two investigators and two graduate nursing students evaluated the data. The process of word and context interpretation was completed using a combination of Tesch (1990) and Creswell (2007) techniques. Data were compared to field notes and debriefing summaries were completed during focus group discussions. Four themes and 12 subthemes evolved from the group discussions. Themes were (a) mothers' social support, (b) interactions with health care providers, (c) barriers in trust, and (d) practical life issues. A conclusion was drawn from these data that these women have difficulty accessing social support and information regarding care of themselves and their newborn infants due to limited social networks and barriers to health care. Nurses are in key positions to offer culturally sensitive social support and identify health care barriers with Hispanic, single, low-income mothers during the transition to motherhood. Further research is needed on interventions that effectively deliver information, lower health care barriers, and meet social support needs of Hispanic, single, low-income mothers and their infants.

New mothers network: the provision of social support to single, low-income, African American mothers via e-mail messages.

Electronic mail (e-mail) is being investigated as a health care intervention for mothers caring for their infants. The purpose of this study is to describe themes representing the content of e-mail messages written by 12 single, low-income, African American mothers to nurses participating in the New Mothers Network Study. Three themes that emerged were (a) life's logistics: day-to-day concerns; (b) relationships of support; and (c) personal reflections about being a new mother. Reported themes support the social support theory based on works by House and Revenson, Schiaffano, Majerovitz, and Gibofski used to develop the nursing intervention. Nurses are in key positions to offer social support to African American mothers adjusting to single parenting. Nurses can provide social support to single, low-income African American mothers via e-mail messages to assist them with caring for themselves and their infants.

New Mothers Network: the development of an Internet-based social support intervention for African American mothers.

Many single, low-income, African American mothers lack social support, experience psychological distress, and encounter difficulties caring for their infants during the transition to parenthood. The purpose of this article is to describe the development of a theoretically-based social support Internet intervention, the New Mothers Network, for improving single, low-income, African American mothers' health and parenting abilities. Conceptual and practical information is provided to describe the evolution of the intervention. The development of the New Mothers Network is described in six stages. The New Mothers Network may be an effective social support nursing intervention for improving single, low-income, African American mothers' psychological health outcomes, parenting outcomes, and health care utilization outcomes.

Using the concept of family strengths to enhance nursing care.

This article was written to help nurses better understand the family strengths framework and encourage them to incorporate family strengths into the nursing care they give. In times of stress or crisis for families, nurses can use the conceptual framework of family strengths as a mechanism to promote strong, healthy relationships. The family strengths perspective identifies and builds on positive attributes in family functioning. Family strengths qualities are (a) commitment, (b) appreciation and affection, (c) positive communication, (d) time together, (e) a sense of spiritual well-being, and (f) the ability to cope with stress and crisis. With the family strengths approach, nurses help families define their visions and hopes for the future instead of looking at what factors contribute to family problems. Family strengths assessment can be used in nursing practice, nursing education, and everyday life.

Effects of high-risk pregnancies on families.

PURPOSE: To examine the psychosocial impact a high-risk pregnancy has on the family and to identify family strengths and how these strengths help families meet the challenges inherent in high-risk pregnancies. STUDY DESIGN AND METHOD: A descriptive study using naturalistic inquiry was used to interview women who were currently pregnant and had differing high-risk obstetric health issues. Data collection for this study included semi-structured, one-on-one audiotaped interviews, observations, and a biographic profile completed by the participant. The audiotaped interviews were transcribed and data were examined, coded, clustered, and sorted into specific categories. Trustworthiness included member checks and audit trails. RESULTS: Three themes emerged from the data about psychosocial impact. Mixed Emotions described the women's perception of a high-risk pregnancy; Adjustment and Support was how the women described their family's experience with the high-risk pregnancy; and Informative Care arose from the women's explanation of care received. The most common family strength identified was the ability to manage stress and crisis, followed by commitment, appreciation and affection, a sense of spiritual well-being, and enjoyable time together. The least common strength identified was positive communication. CLINICAL IMPLICATIONS: A high-risk pregnancy not only affects women, but it also causes an alteration in family functioning. Nurses need to become familiar with family strengths and help families recognize their strengths when faced with significant life events.

Needs, concerns, and social support of single, low-income mothers.

The purposes of this qualitative pilot study were to describe needs and concerns of single, low-income mothers and to evaluate social support mechanisms these mothers valued during the transition to parenthood. Qualitative analysis consisted of word and context interpretation from focus group data. The following themes resulted from the discussion: (a) transition: resilience, finding new direction, and an array of emotions and mixed feelings; (b) stress: loss, isolation, and barriers; and (c) social support: positive and negative social support, and the need for informational, appraisal, emotional, and tangible support. Nursing interventions are discussed.

Effects of the New Fathers Network on first-time fathers' parenting self-efficacy and parenting satisfaction during the transition to parenthood.

The effectiveness of an Internet-based intervention, the New Fathers Network, was tested in improving first-time fathers' parenting self-efficacy and parenting satisfaction during the first 8 weeks following their infants' birth as compared with no intervention (Comparison Group). Parenting self-efficacy and satisfaction scores for the Intervention Group significantly improved from 4 to 8 weeks; parenting self-efficacy and satisfaction scores for the Comparison Group to which no intervention was given did not change significantly. Participants were primarily satisfied with the New Fathers Network.

Chewing tobacco use: perceptions and knowledge in rural adolescent youths.

The purposes of this pilot study were to describe the incidence of chewing tobacco use among rural midwestern adolescents and to describe rural midwestern adolescents' perceptions and knowledge about chewing tobacco use. A Smokeless Tobacco Use Survey was administered to 34 adolescent subjects who attended 5th-8th grades in two rural towns. None of the subjects reported trying chewing tobacco products. However, a group of male subjects who stated they may chew tobacco sometime in the future, performed less well on the test about chewing tobacco facts and perceptions of use, indicating some education needs are warranted. Risk factors and deterrent factors to using chewing tobacco are reported.

Marital and parenting satisfaction and infant care self-efficacy during the transition to parenthood: the effect of infant sex.

The purpose of this follow-up study was to examine the effect of infant sex on changes in and differences between parents' reports of infant care self-efficacy and parenting and marital satisfaction from 4 months to 12 months after the birth of their first child. A convenience sample of 32 couples was selected from 44 couples who participated in a longitudinal study of the development of parenting satisfaction and infant care self-efficacy during the first 4 months after the birth of a first child (Brage Hudson, Elek, Fleck, 2001). Couples completed a demographic questionnaire, the Infant Care Survey (ICS, Froman Owen, 1989), the What Being the Parent of a New Baby is Like--Revised Questionnaire (WPBL-R, Pridham Chang, 1989), and the Dyadic Adjustment Scale (DAS, Spanier, 1976, 1989) 4 and 12 months postpartum. Infant care self-efficacy, but not parenting satisfaction, increased from 4 to 12 months; mothers reported higher infant care self-efficacy and parenting satisfaction than fathers at both times. Fathers of boys reported greater parenting satisfaction and infant care self-efficacy at 12 months than fathers of girls. Marital satisfaction decreased from 4 to 12 months for both mothers and fathers. Significant relationships existed among infant care self-efficacy, parenting satisfaction, and marital satisfaction at both 4 and 12 months postpartum. Implications for families and for nursing interventions are discussed.