The personal experience of pregnancy for African-American women

Differences in Psychosocial Protective Factors by Race/Ethnicity and Socioeconomic Status and Their Relationship to Preterm Delivery

Background: Non-Hispanic Black (“Black”) women in the United States deliver preterm at persistently higher rates than non-Hispanic White (“White”) women, and disparities in preterm delivery (PTD) also exist by socioeconomic factors. Research is needed to identify and understand factors that are protective against PTD for Black women and low socioeconomic status (SES) women.

Methods: We examined seven potential protective factors at the individual, interpersonal, and neighborhood levels during pregnancy to determine if they (1) differed in prevalence by race/ethnicity and SES and (2) were associated with risk of PTD overall or within specific race/ethnicity and SES groups. We used prospectively collected data from n = 2474 women who were enrolled in the Pregnancy Outcomes and Community Health Study conducted in Michigan (1998–2004).

Results: White women reported higher levels of self-esteem, mastery, perceived social support, instrumental social support, and reciprocity compared to Black women (all p < 0.01), while Black women reported higher levels of religiosity compared to white women (p < 0.01). High SES women reported higher levels of all protective factors compared to middle and low SES women (all p < 0.01). While protective factors were not independently associated with PTD, religiosity was associated with lower odds of PTD among low SES women (OR 0.6, 95% CI 0.4-0.9) and among Black women (OR 0.6, 95% CI 0.4–1.0), respectively.

Conclusions: Our findings highlight the importance of assessing how protective factors may operate differently across race/ethnicity and SES to promote healthy pregnancy outcomes. Future studies should examine mechanisms that elucidate potential causal pathways between religiosity and PTD for Black women and low SES women.

Wise Women's Provision of Maternal-Child Health Information and Support for Urban, African American Women

Introduction: The United States is experiencing a maternal-child health (MCH) crisis including racial inequalities in mortality. This study explored the roles of lay experts who provide information and support to women of childbearing age (i.e., Wise Women) and cultural norms for sharing MCH information and support in an urban, predominantly African American community. Methodology: This qualitative community-engaged study (N = 49) of social networks utilized a semistructured guide and brainstorming activities with eight focus groups (three community leader, three community women, and two Wise Women). Results: Although several sources of MCH information and support were noted, Wise Women were the most frequently reported culturally normative sources. Emergent themes included positive affirmations for informal exchange of MCH information among women and roadblocks to MCH information exchange and support. Discussion: Results suggest a need for culturally relevant interventions that would strengthen lines of communication and social connectedness among African American women.

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.

Stressors, resources, and stress responses in pregnant African American women: a mixed-methods pilot study

This research aimed to develop an initial understanding of the stressors, stress responses, and personal resources that impact African American women during pregnancy, potentially leading to preterm birth. Guided by the ecological model, a prospective, mixed-methods, complementarity design was used with 11 pregnant women and 8 of their significant others. Our integrated analysis of quantitative and qualitative data revealed 2 types of stress responses: high stress responses (7 women) and low stress responses (4 women). Patterns of stress responses were seen in psychological stress and cervical remodeling (attenuation or cervical length). All women in the high stress responses group had high depression and/or low psychological well-being and abnormal cervical remodeling at one or both data collection times. All but 1 woman had at least 3 sources of stress (racial, neighborhood, financial, or network). In contrast, 3 of the 4 women in the low stress responses group had only 2 sources of stress (racial, neighborhood, financial, or network) and 1 had none; these women also reported higher perceived support. The findings demonstrate the importance of periodically assessing stress in African American women during pregnancy, particularly related to their support network as well as the positive supports they receive.

Provider characteristics desired by African American women in prenatal care

PURPOSE

The purpose of this study was to describe provider characteristics African American pregnant women identified as important when interacting with their prenatal care providers in an outpatient office setting.

STUDY DESIGN

A descriptive qualitative design was used to explore provider characteristics desired by African American women receiving prenatal care at two inner-city hospital-based obstetric clinics. A total of 22 African American women between the ages of 19 and 28 years participated in the study.

FINDINGS

Four major provider characteristic themes emerged from the data: (a) demonstrating quality patient-provider communication, (b) providing continuity of care, (c) treating the women with respect, and (d) delivering compassionate care.

DISCUSSION

An overarching theme revealed by the data analysis was the desire by African American women in this study to have their prenatal providers know and remember them. They wanted their providers to understand the context of their lives from their prenatal interactions. Incorporating findings from this study to improve patient-provider interactions during prenatal care could provide an increased understanding of the many complex variables affecting African American women's lives.

IMPLICATIONS

Prenatal care provides an opportunity for African American women to develop a trusting relationship with a provider. Developing models of prenatal care congruent with the realities of African American women's lives has the potential to improve patient- provider interactions and potentially affect birth outcomes.

Voices from the battlefield: reports of the daily experiences of urban Black mothers

There are persistent disparities in maternal child health in the United States. In this study I used an ethnographic design to portray the everyday lives of 130 Black, low-income, urban mothers. The women described daily battles related to a lack of material and human resources. To deal with these challenges, they assumed the role of soldiers, developed new tactical maneuvers, trusted in God for justice, shared their resources with their comrades, took short-lived breaks when they were wounded in action, and used escape mechanisms. Public health interventions are needed to deal with infrastructural deficits and support the women's defenses.

Psychometric characteristics of the spiritual perspective scale in pregnant African-American women

In health disparities research, studying the vulnerabilities of African Americans should be balanced by research on resources and strengths that influence health. One resource is spirituality, yet few tools have been developed and tested in diverse populations. This study evaluated the psychometric characteristics of the Spiritual Perspective Scale (SPS) in 102 pregnant African American women. Internal consistency reliability was high and evidence of construct validity was provided. The SPS correlated as hypothesized with church attendance, religiosity, and self-reported spirituality. In addition, the SPS correlated negatively with depression, anxiety, and stress. Factor analysis revealed a two-factor solution. The SPS performed well suggesting that it is an appropriate tool to use as a measure of spirituality in pregnant African American women.

Transition: a literature review

AIM

This paper reports a comprehensive literature review exploring how the term 'transition' has been used in the health literature.

BACKGROUND

The meaning of transition has varied with the context in which the term has been used. The last 3 decades have seen altered understandings in the concept of transition in the social science and health disciplines, with nurses contributing to more recent understandings of the transition process as it relates to life and health.

METHOD

The CINAHL, Medline, Sociofile and Psychlit databases were accessed and papers published between 1994 and 2004 were retrieved to answer the questions 'How is the word transition used?' and 'What is the concept of transition informing?' Transition theoretical frameworks were also explored.

FINDINGS

Widespread use of the word 'transition' suggests that it is an important concept. Transitional definitions alter according to the disciplinary focus, but most agree that transition involves people's responses during a passage of change. Transition occurs over time and entails change and adaptation, for example developmental, personal, relational, situational, societal or environmental change, but not all change engages transition. Reconstruction of a valued self-identity is essential to transition. Time is an essential element in transition and therefore longitudinal studies are required to explore the initial phase, midcourse experience and outcome of the transition experience.

CONCLUSION

Transition is the way people respond to change over time. People undergo transition when they need to adapt to new situations or circumstances in order to incorporate the change event into their lives. Transition is a concept that is important to nursing; however, to further develop understandings, research must extend beyond single events or single responses. Longitudinal comparative and longitudinal cross-sectional inquiries are required to further develop the concept.

A study of midlife women's reasons for changing healthcare providers

PURPOSE

The purpose of this study was to examine the reasons midlife women report for changing healthcare providers and to determine if there were any differences in reasons given for the change based on gender or ethnicity.

DATA SOURCES

This was an analysis of data collected from a healthy community-based sample of midlife women as part of a longitudinal 5-year study of changes in health outcomes during transition to menopause. Women were queried about their experience in changing healthcare providers.

CONCLUSIONS

Over 42% indicated that they had changed health providers because of dissatisfaction with care. The component accounting for the majority of the variance was related to communication issues. There were no significant differences across ethnic groups in decision to change providers or in reasons for their dissatisfaction with care. However, their reports of experiencing racism in the healthcare system were troubling.

IMPLICATIONS FOR PRACTICE

The ability of the provider to communicate with women may have implications in women's choices in health care later in life.

Community Leaders' Perceptions of Single, Low-Income Mothers' Needs and Concerns for Social Support

Purposes of this study were to (a) assess and describe needs and concerns of single, low-income mothers during their transition to parenthood from the perspective of 16 Midwestern community leaders working closely with families and (b) evaluate social support mechanisms that are available for families. Focus group questions were organized around social support theory to gather information. The following themes evolved from focus group discussions: (a) social support issues (emotional, tangible, informational, and appraisal support; positive and negative support); (b) personal barriers to success (stress, low self-esteem, isolation, and inadequate parenting competence); and (c) system barriers (fear of the system and insensitive and ineffective services). Community health nursing strategies were identified that include assessment and interventions for this vulnerable population throughout their infants' 1st year of life and beyond.

Health care implications and space allocation of research published in nursing journals

PURPOSE

To examine how research is disseminated through nursing journals and to examine characteristics of published research.

DESIGN

A cross-sectional descriptive survey was conducted with manuscripts from 78 nursing journals that publish research.

METHOD

The final issue for 1999 was examined. Pairs of independent raters content-analyzed all research manuscripts.

DISCUSSION

Research studies comprised 241 (42.9%) of the manuscripts and 51.4% of the journal space. Many empirical studies omitted validity and reliability. Few manuscripts reported the date for completion of data collection, and fewer than one third contained the length of time from acceptance to publication.

CONCLUSIONS

Enhanced instrumentation reporting, shorter time from data collection to publication, and an increase in journal space devoted to research might enable nurses to make more cutting-edge clinical decisions.

Grief is more than tears

Much has been written in the professional and popular literature about grief. The multiplicity of sources for information about the phenomenon often leads to confusion regarding terminology and process. In addition, assessment and intervention methods show the phenomenon as unidimensional despite evidence to the contrary. Because nursing routinely deals with grief, it is important that a framework be developed to help understand the process and guide appropriate interventions. The Neuman systems model is particularly well suited as a framework because concepts found in the model are similar to descriptions of the concept of grief. An analysis of the grief concept using the Neuman model is presented, with perinatal grief presented as an example.