The influence of social‐developmental context and nurse visitation intervention on self‐agency change in unmarried adolescent mothers

Pregnancy among unmarried adolescents has been linked to negative personal control beliefs. In contrast, self‐agency beliefs about control over future possibilities have been linked to delay in subsequent childbearing. In this secondary analysis, we examined factors associated with self‐agency change in 429 unmarried adolescent mothers from intervention and control groups of a nurse home visitation study. Adolescent mothers who participated in a sustained relationship with a nurse made greater gains in self‐agency than did control group mothers (p = .034). Adolescents with lower cognitive ability who were behind their age‐appropriate grade level in school made the greatest self‐agency gains. © 2013 Wiley Periodicals, Inc. Res Nurs Health 36:158–170, 2013     

Study protocol for a multisite randomized controlled trial of an internet and mobile‐based intervention for preventing and reducing perinatal depressive symptoms

Nearly 20% of women in the United States experience clinically significant depressive symptoms during pregnancy or the postpartum period. These women may benefit from easily accessible, nonpharmacologic, and inexpensive self‐management approaches, such as via internet and mobile‐based interventions, to prevent development of symptoms and/or intervene with current symptoms. This paper summarizes the research protocol of a nationally‐funded large‐scale randomized controlled study to evaluate “Mamma Mia,” a self‐guided program with 44 modules that women use throughout pregnancy to 6 months postpartum. The program contains a novel combination of components designed to enable women to enhance self‐efficacy, emotional self‐regulation, and perceived social support. The overall goal of this three‐arm longitudinal randomized controlled trial is to evaluate the effects and mechanisms of this self‐management approach in diverse women in the U.S. (n = 1950). Enrolled pregnant women will be randomly assigned to one of three groups: (1) “Mamma Mia” alone, which is self‐guided; (2) “Mamma Mia Plus” in which participants engage in the “Mamma Mia” modules plus receive brief guided support from a registered nurse; or (3) usual prenatal/postpartum care. The first specific aim is to evaluate effects by group on the primary outcome of interest, depressive symptoms, over time. The second aim is to evaluate effects by group on subjective well‐being, anxiety, and stress. Using a conceptual framework based upon Individual and Family Self‐Management Theory, the third aim is to evaluate possible mediators (self‐efficacy, emotion self‐regulation, perceived support) and possible moderators (e.g., race/ethnicity, type of healthcare clinician) of this self‐management approach.     

Listening with care: using narrative methods to cultivate nurses’ responsive relationships in a home visiting intervention with teen mothers

Effective public health nursing relies on the development of responsive and collaborative relationships with families. While nurse–family relationships are endorsed by home visitation programs, training nurses to follow visit‐to‐visit protocols may unintentionally undermine these relationships and may also obscure nurses’ clinical understanding and situated knowledge. With these issues in mind, we designed a home‐visiting intervention, titled Listening with Care, to cultivate nurses’ relationships with teen mothers and nurses’ clinical judgment and reasoning. Rather than using protocols, the training for the intervention introduced nurses to narrative methods and therapeutic tools. This mixed‐method pilot study included a quasi‐experimental design to examine the effect of the intervention on teen mothers’ depressive symptoms, self‐silencing, repeat pregnancy, and educational progress compared to teens who received usual care. Qualitative data were collected from the nurses to evaluate the feasibility and acceptability of the intervention and therapeutic tools. The nurses endorsed the therapeutic tools and expected to continue using them in their practice. Despite the lack of statistically significant differences in outcomes between groups, findings suggest that further study of the intervention is warranted. Future studies may have implications for strengthening hidden aspects of nursing that make a difference in the lives of teen mothers.     

Meeting the "Now" Need: PMH-APRN-- Interpreter Teams Provide In-Home Mental Health Intervention for Depressed Latina Mothers With Limited English Proficiency

Latina mothers of infants and toddlers are at high risk for developing serious depressive symptoms if they are newly immigrated and have limited English proficiency (LEP). Depressive symptoms compromise these mothers and result in severe consequences for their U.S.-born children. A randomized clinical trial of a short-term, in-home psychotherapy intervention for symptomatic mothers in an area of the United States where bilingual mental health providers were scarce used teams of English-speaking advanced practice psychiatric mental health nurses and bilingual community interpreters who were trained in a conduit, consecutive model of interpretation. The article describes the development of a theoretically congruent interpreter model, the training program that supported it, the challenges that surfaced and lessons learned during successful implementation in the field. Future refinements in progress and uses of the model are discussed.     

A randomized controlled trial of a video module to increase U.S. poison center use by low-income parents

Context. U.S. poison centers decrease medical visits by providing telephone advice for home management of potential poisonings, but are underutilized by low-income African-American and Latino parents, and those with limited English proficiency, due to lack of knowledge and misconceptions about poison centers. Objectives. To assess the effectiveness of a poison prevention video module in improving knowledge, behavior, and behavioral intention concerning use of poison centers in a population of low-income, language-diverse adults attending parenting courses offered by a community organization. Methods. A randomized, blinded, controlled trial was conducted at 16 parenting course sites of a community organization and included 297 participants. The organization's instructors presented the video module (intervention) or the usual class curriculum (control). Participants completed questionnaires at baseline and a telephone interview 2–4 weeks later. Changes from baseline to follow-up were compared between the intervention and control groups using analysis of variance and Chi-square tests. Intervention group participants were stratified by English proficiency and compared to assess baseline and follow-up responses by language. Results. After the intervention, participants in the intervention group had a significantly greater increase in knowledge about the poison center, were more likely to have the correct poison center phone number at home, and had greater behavioral intention to use the poison center compared to control group participants. At baseline, Spanish-primary-language participants with limited English proficiency had less knowledge about the poison center, were less likely to have the poison center number at home, and had lower behavioral intention to use the poison center than English proficient participants, but significantly improved after the intervention. Conclusions. This video module, when presented by a community organization's instructors, was highly effective in improving knowledge, behavior, and behavioral intention concerning use of poison centers within a low-income, language-diverse population.     

Anxiety Among Black and Latina Mothers of Premature Infants at Social-Environmental Risk

Anxiety is heightened for mothers of premature infants, potentially interfering with early mothering. This study describes relationships among race/ethnicity, language, and anxiety for women at social-environmental risk who deliver a premature infant. Postnatal baseline interview data from a randomized trial testing a behavioral intervention for mothers and infants (29–34 weeks gestational age) were used to examine maternal state (State-Trait Anxiety Inventory Y1) and trait (State-Trait Anxiety Inventory Y2) anxiety among blacks and Latinas, and by language preference. Latinas (n = 97) had an elevated prevalence of high (≥ 40) state anxiety compared to blacks (n = 97), with Latinas preferring a Spanish to an English interview reporting the highest levels of state anxiety. Trait anxiety did not differ across groups. Culturally appropriate interventions are needed to reduce anxiety among Latina mothers delivering premature infants, especially among those with limited English language proficiency. The combination of a racially/ethnically diverse workforce, bilingual healthcare providers, and trained medical interpreters may help to ensure better outcomes.     

Effectiveness of home visits by mental health nurses for Japanese women with post‐partum depression

Post‐partum depression affects 10–13% of Japanese women, but many do not receive appropriate treatment or support. This intervention study evaluated the effectiveness of home visits by mental health nurses for Japanese women with post‐partum depression. Eighteen post‐partum women met the inclusion criteria and were randomly allocated into the intervention (n = 9) or control (n = 9) group at 1–2 months after giving birth. The intervention group received four weekly home visits by a mental health nurse. Control group participants received usual care. Two women in the intervention group did not complete the study. Depressive symptoms and quality of life were measured at 1 and 6 weeks' postintervention. In addition, participants completed an open‐ended questionnaire on satisfaction and meaning derived from the home visits. Women in the intervention group had significant amelioration of depressive symptoms over time and reported positive benefits from the home visits, but there were no statistically significant differences between groups. Significant differences (P < 0.05) were observed at times 2 and 3 between groups in terms of increased median scores of physical, environmental, and global subscales, and the total average score of the World Health Organization/quality of life assessment instrument. On the psychological subscale, significant differences (P = 0.042) were observed between groups at time 2. The qualitative analysis of comments about home visitation revealed four categories related to ‘setting their mind at ease’, ‘clarifying thoughts’, ‘improving coping abilities’, and ‘removing feelings of withdrawal from others’. These results suggest that home visits by mental health nurses can contribute to positive mental health and social changes for women with post‐partum depression. A larger trial is warranted to test this approach to care.     

Effects of a community‐based intervention on cardio‐metabolic risk and self‐care behaviour in older adults with metabolic syndrome

This pilot study was performed to investigate the effects of a community‐based intervention (CBI) on cardio‐metabolic risk and self‐care behaviour in 92 older adults with metabolic syndrome at public health centres in Suwon, Korea. A prospective, pretest and posttest, controlled, quasi‐experimental design was used. The older adults in the intervention group participated in an 8‐week intensive lifestyle counselling, whereas those in the control group received usual care. The mean (standard deviation) age of the participants was 71.4 (4.43) years ranging from 60 to 84, and 75.0% of the participants were female. The intervention group at 8 weeks showed significant reduction in waist circumference by ?1.35 cm (P < 0.001) and improved self‐care behaviour (+ 5.17 score, P < 0.05) and self‐efficacy (+ 4.84 score, P < 0.001) when compared with the control group. The percentages of those who successfully completed the targeted behavioural modification were 71.7% for exercise and 52.2% for dietary control in the intervention group at 8 weeks. This pilot study provided evidence of the beneficial impact of the CBI for Korean older adults with metabolic syndrome.     

Positive psychotherapy for depression and self‐efficacy in undergraduate nursing students: A randomized,controlled trial

Nursing students across the globe experience depressive symptoms, and many interventions have been used to alleviate their depression. However, few interventions focus on students' personal strengths and advantages. The aim of the present study was to explore the effects of an 8‐week group positive psychotherapy (PPT) programme on depression and self‐efficacy in full‐time undergraduate nursing students. A randomized, controlled trial was conducted for 76 nursing students (34 in the experimental group, 42 in the control group). The Beck Depression Inventory‐II and the General Self‐Efficacy Scale were used to collect data prior to, immediately after PPT, 3 months', and 6 months' post‐PPT. Repeated‐measures analysis of variance indicated that the intervention significantly alleviated depression and improved self‐efficacy (each P < 0.05); the effect of time and time–group interaction was also significant (each P < 0.05). The findings suggest that PPT could significantly relieve depressive symptoms and improve self‐efficacy. We recommend that PPT is effective in alleviating depression and improving self‐efficacy in undergraduate nursing students. Academic mental health nurses should appreciate the value of PPT and consider incorporating it in psychological support methods in order to facilitate nursing students' mental health.     

The effect of reminiscence therapy on quality of life,attitudes to ageing,and depressive symptoms in institutionalized elderly adults with cognitive impairment: A quasi‐experimental study

The aim of this study was to analyse the effect of group narrative reminiscence therapy on cognition, quality of life, attitudes towards ageing, and depressive symptoms in a group of older adults with cognitive impairment in institutional care. A quasi‐experimental pretest/post‐test control group design was employed. Interventions involving reminiscence therapy with a narrative approach were included in the care plan and implemented in groups of between five and ten respondents once a week for 8 weeks (total 59 participants). The members of the control group (n = 57) received standard care. A study questionnaire was designed to measure demographic characteristics, quality of life (WOHQOL‐BREF, WHOQOL‐OLD), depressive symptoms (GDS), cognition (MMSE), and attitudes towards ageing (AAQ). Reminiscence therapy positively affected older adults’ quality of life (mostly the areas of mental health and social participation), and also their attitudes to ageing and old age. It reduced symptoms of depression, but had no discernible effect on cognitive function. Reminiscence therapy can positively affect selected aspects of quality of life, attitudes towards old age, and symptoms of depression in the elderly in long‐term healthcare facilities. Group reminiscence therapy can be used as a nursing intervention.     

Influence of support by elderly persons on Japanese mothers' child care‐related stress

This study examined the influence of child‐care support by elderly persons on mothers' child care‐related stress in Japan. A cross‐sectional study was conducted from February to April 2007 by using an anonymous questionnaire. This study focused on the “child‐care salon” (hereafter referred to as “salon”) as a type of parenting support activity by elderly persons in the community. For the analysis, 119 salon participants and a control group of 107 mothers who had not participated in a salon were recruited. As a result of a multiple regression analysis, participation or non‐participation in the salon had no influence on the ‘threat of loss of personal identity’ stress, which was similar to a sense of social isolation because of child care. However, as a result of investigating the influence of the participation frequency on stress score for participants alone, mothers with less participation had a higher stress score than mothers with greater participation. That suggested the importance of intervention for a decrease of social isolation in mothers, especially in the initial stage of salon participation.     

Self‐worth therapy for depressive symptoms in older nursing home residents

Title. Self‐worth therapy for depressive symptoms in older nursing home residents. Aim. The aim of this study is to report the effects of self‐worth therapy on depressive symptoms of older nursing home residents. Background. Depression in older people has become a serious healthcare issue worldwide. Pharmacological and non‐pharmacological therapies have been shown to have inconsistent effects, and drug treatment can have important side‐effects. Method. A quasi‐experimental design was used. Older people were sampled by convenience from residents of a nursing home in northern Taiwan between 2005 and 2006. To be included in the study participants had to: (i) have no severe cognitive deficits; (ii) test positive for depressive status and (iii) take the same anti‐depressant medication in the previous 3 months and throughout the study. Participants in the experimental group (n = 31) received 30 minutes of one‐to‐one self‐worth therapy on 1 day a week for 4 weeks. Control group participants (n = 32) received no therapy, but were individually visited by the same research assistant, who chatted with them for 30 minutes on 1 day/week for 4 weeks. Depressive status, cognitive status and functional status were measured at baseline, immediately after the intervention and 2 months later. Data were analysed by mean, standard deviations, t‐test, chi‐squared test and univariate anova . Findings. Self‐worth therapy immediately decreased depressive symptoms relative to baseline, but not relative to control treatment. However, 2 months later, depressive symptoms were statistically significantly reduced relative to control. Conclusion. Self‐worth therapy is an easily‐administered, effective, non‐pharmacological treatment with potential for decreasing depressive symptoms in older nursing home residents.     

Predictors of psychological distress in low‐income mothers over the first postpartum year

Up to 25% of postpartum women experience psychological distress including stress, depressive, or anxiety symptoms during the postpartum period. The purpose of this study was to explore the extent to which social determinants of health and allostatic load score, a 10‐item index of biologic measures of chronic stress, predict psychological distress in low‐income pregnant women over the first postpartum year. We conducted a secondary data analysis of the Child Community Health Research Network data set. The psychological distress outcome variables were perceived stress (n = 842), depression ( n = 845), and anxiety ( n = 846) symptoms, all measured categorically over the first year postpartum (T1:1 month, T2: 24–29 weeks, and T3: 50–65 weeks). Our predictors were social determinants of health (e.g., demographics, maternal hardship, percent poverty level, interpersonal violence, and food security) and allostatic load score. Generalized linear mixed models were used to determine which predictors were significantly associated with psychological distress symptoms across the first postpartum year. Interpersonal violence was a statistically significant risk factor for stress, depression, and anxiety symptoms over the first year postpartum. Other significant risk factors included low‐income level, nativity, and perceived food security. Receiving food stamps was a significant protective factor for stress symptoms. The significance of risk factors for psychological distress, both modifiable and nonmodifiable, can be used as potential targets for further research, screening, and intervention. Future work should explore why and in what conditions these risk factors vary over time.     

Effectiveness of teaching an early parenting approach within a community-based support service for adolescent mothers

A single blind, pre-test, post-test design was used to test the effectiveness of the Keys to Caregiving Program in enhancing adolescent mother-infant interactions. Participants were sequentially allocated to groups in order of referral. The outcome was the enhancement of maternal and infant behaviors that exhibited mutual responsiveness as measured by the Nursing Child Assessment Teaching Scale. Issues with recruitment and collaboration with the community agencies made achieving a desirable sample size difficult. Pre-tests and post-tests were completed for 13 participants. While the sample size was insufficient to confidently establish whether or not the Keys to Caregiving produced a between groups treatment effect, mothers within the treatment group evidenced significantly greater contingent responsiveness over time than those within the control group.     

A tailored educational intervention improves doctor's performance in managing depression: a randomized controlled trial

Rational and objectives To assess the effects of a tailored and activating educational intervention, based on a three‐stage modified Prochaska model of readiness‐to‐change, on the performance of general physicians in primary care (GPs) regarding management of depressive disorders. Methods Parallel group, randomized control trial. Primary hypothesis was that performance would improve by 20 percentage units in the intervention arm. The setting was primary care in southern Tehran. The participants were 192 GPs stratified on stage of readiness‐to‐change, sex, age and work experience. The intervention was a 2‐day interactive workshop for a small group of GPs' at a higher stage of readiness‐to‐change (‘intention’) and a 2‐day interactive large group meeting for those with lower propensity to change (‘attitude’) at the pre‐assessment. GPs in the control arm participated in a standard educational programme on the same topic. The main outcome measures were validated tools to assess GPs' performance by unannounced standardized patients, regarding diagnosis and treatment of depressive disorders. The assessments were made 2 months before and 2 months after the intervention. Results GPs in the intervention arm significantly improved their overall mean scores for performance regarding both diagnosis, with an intervention effect of 14 percentage units (P = 0.007), and treatment and referral, with an intervention effect of 20 percentage units (P < 0.0001). The largest improvement after the intervention appeared in the small group: 30 percentage units for diagnosis (P = 0.027) and 29 percentage units for treatment and referral (P < 0.0001). Conclusions Activating learning methods, tailored according to the participants' readiness to change, improved clinical performance of GPs in continuing medical education and can be recommended for continuing professional development.