Social Determinants of Health and Parenting Self-Efficacy Among Mothers of Preterm Infants

Objective: To explore the relationships between social and environmental factors and parenting self-efficacy (PSE) among mothers of preterm infants hospitalized in neonatal intensive care units (NICUs) using a social determinants of health (SDoH) framework. Method: We analyzed data from a prospective cohort study that included 187 mother-infant dyads admitted to four NICUs in the Mountain West region between June 2017 and December 2019. We used multivariable linear regression models to assess the independent associations between maternal and infant characteristics and PSE. Results: Our final multiple linear regression model predicting the efficacy score including maternal race/ethnicity, age, insurance, employment status before giving birth, gestational age, depression, and having other children was significant (F(12,160) = 3.17, p = .0004, adjusted R¬2 = .131). Significant predictors of PSE were race/ethnicity (β= 3.3, p = .022), having another child/children (β= 4.2, p = .005), and depression (β= -4.2, p = .004). Conclusions: Findings suggest that social workers and medical practitioners should consider SDoH, such as insurance type, household income, and employment, along with traditional clinical indicators when assessing families’ infant care needs. Social workers, medical practitioners, and researchers should be mindful of how implicit bias may influence the allocation of care and parental supports

Exploring the Relationship Between Historical Redlining and Place-Based Reproductive Health Inequities: A Qualitative GIS Approach

Individual-level risk factors and characteristics do not fully explain racial, ethnic, and socioeconomic inequities in preterm birth in the United States, and evidence suggests that medical advancements, increased access to prenatal care, and high per-capita spending on health care have done little to reduce these inequities. Health inequities research has shifted its attention from individual-level factors that influence health outcomes to the social determinants of health. Neighborhoods, considered an important upstream social determinant of health, can influence health outcomes through their social, service, and physical environments, and have been consistently linked to birth outcomes. Despite increased attention to neighborhood influences on reproductive health, there is limited attention to the historical macrostructural determinants of neighborhood conditions and place-based reproductive health inequities. Guided by feminist neighborhood political ecology, this study used Qualitative GIS to explore the relationship between historical redlining, contemporary neighborhood conditions, and spatial clusters of preterm birth in Denver, Colorado. Using an explanatory sequential mixed methods design, the geospatial strand first examined the spatial distributions of live births (N = 45,307) and preterm births (n = 4,005), identified statistically significant high value (hot spot) and low value (cold spot) clusters of preterm birth, and examined the neighborhood-level sociodemographic and environmental characteristics for the most intensely clustered preterm birth hot spot and cold spot. The most intensely clustered preterm birth hot spot and cold spot identified in the geospatial strand were used to target neighborhoods for qualitative interview recruitment to explore maternal perceptions of neighborhood influences on their reproductive health. Due to the COVID-19 pandemic, no participants were successfully recruited for the qualitative strand, resulting in no qualitative or mixed methods analysis for this study. Overall, this study found that high value clusters of preterm birth did not overlap with historically redlined neighborhoods, but rather occurred in the geographically segregated area of the city characterized by a greater concentration of Black residents and poorer quality service and physical environments. Spatial analysis also indicated that most of Denver’s historically redlined neighborhoods are now gentrified. These findings suggest that spatial inequities in preterm birth may be related to the contemporary pattern of Black residential segregation and a lack of investment in health-promoting infrastructure and opportunities in segregated neighborhoods. This study’s findings point to the need for additional research to understand what specific neighborhood-level characteristics are associated with preterm birth hot spots and how spatiotemporal dynamics influence the spatial clustering of preterm birth in Denver. Implications for policy and practice are also discussed

Mothers\u27 Experiences in the NICU Before Family-Centered Care and in NICUs Where It Is the Standard of Care

Background: Family-centered care (FCC) in neonatal intensive care units (NICUs) was initiated in 1992 to promote a respectful response to individual family needs and support parental participation in care and decision-making for their infants. Although benefits of FCC have been reported, changes in the maternal experience in the NICU are unknown. Purpose: The purpose of this study was to compare mothers\u27 experiences in NICUs where FCC is the standard of care and to compare these with the experiences of mothers 2 decades ago. Methods: In this qualitative descriptive design, mothers of infants born under 32 weeks postconceptional age were asked to describe their experiences with their infant\u27s birth and hospitalization. Open-ended probing questions clarified maternal responses. Saturation was reached after 14 interviews. Iterative coding and thematic grouping was used for analysis. Results: Common themes that emerged were: (1) visiting; (2) general caregiving; (3) holding; (4) feeding; and (5) maternal ideas for improvement. Findings indicated important improvements in privacy, mother–nurse relationship, ease of visiting, and maternal knowledge and participation in infant caregiving. Implications for Practice: Mothers suggested improvements such as additional comforts in private rooms, areas in the NICU where they can meet other mothers, and early information on back-transport. Better recognition and response for mothers without adequate social support would provide much needed emotional assistance. Implications for Research: Future research addressing benefits of webcams, wireless monitors, back-transport, maternity leave, and accommodations for extended visiting for siblings would address other needs mentioned by mothers

Mothering in the NICU: A Qualitative Exploration of Maternal Engagement

Research suggests maternal engagement in the neonatal intensive care unit (NICU) may positively impact maternal and infant health outcomes. However, the U.S. has lower rates of maternal engagement in the NICU compared to other developed countries. This qualitative study reflects a transdisciplinary research partnership between social work, nursing, and neonatology. Qualitative inquiry explores maternal experiences in the NICU from the perspectives of mothers of preterm infants hospitalized in 2 U.S. NICUs. Results support an ecological systems framework to understanding barriers and facilitators to maternal engagement in the NICU and the utilization of a trauma-informed health care approach in NICU settings

NICU Visitation Time and Adherence to Safe Sleep Practices Among Mothers of Very Preterm Infants.

Sleep-associated infant death is the leading cause of postneonatal mortality in the United States. Preterm infants are at higher risk for sleep-associated death, but maternal adherence to safe sleep practices is lower than for mothers of full-term infants. Data are lacking on whether maternal neonatal intensive care unit (NICU) visitation time impacts safe sleep compliance after hospital discharge

Defining an Infant\u27s Race and Ethnicity: A Systematic Review.

Infant race and ethnicity are used ubiquitously in research and reporting, though inconsistent approaches to data collection and definitions yield variable results. The consistency of these data has an impact on reported findings and outcomes

The Association of Social Factors and Time Spent in the NICU for Mothers of Very Preterm Infants.

METHODS In this prospective observational cohort study, we enrolled mother–infant dyads whose infants were bornweeks\u27 gestation. Enrollment occurred after 2 weeks of NICU exposure, when maternal social factors and demographic information was collected. Maternal time spent in the NICU was abstracted from the electronic medical record and was dichotomized into 0 to 6 days and ≥6 days per week. Demographic differences between the 2 groups were compared by using χ2 tests. Logistic regression was used to assess the independent association between maternal social factors and the average number of days per week spent in the NICU. RESULTS A total of 169 mother–infant dyads were analyzed. Maternal social factors associated with more time spent in the NICU included an annual household income of \u3e$100 000, compared with those with an annual household income of60 minutes [aOR: 7.85; 95% CI 2.81–21.96]), and the lack of other children in the household, compared with women with other children (aOR: 3.15; 95% CI 1.39–7.11). CONCLUSIONS Maternal time spent in the NICU during a prolonged birth hospitalization of a very preterm infant differed by socioeconomic status, travel time, and presence of other dependents. Strategies to better identify and reduce these disparities to optimize engagement and, subsequently, improve infant health outcomes is needed

Comparisons of Three Measures of Maternal Engagement Activities in the Neonatal Intensive Care Unit

Background: Mothers’ engagement with their hospitalized preterm infant(s) is recognized as an important aspect of treatment in neonatal intensive care units (NICUs). However, no gold standard exists for measuring maternal engagement, and the various methods used to measure mothers’ time have documented limitations. Objectives This study sought to compare three measurement methods of maternal engagement (a five-item maternal cross-sectional survey, time use diaries, and electronic health records [EHRs]) to identify whether these methods capture consistent data and patterns in detected differences in measures of engagement. Methods Maternal engagement was defined as time spent visiting the infant in the NICU (presence), holding (blanket holding in the mother’s arms or by kangaroo care [KC]), and caregiving (e.g., bathing and changing diapers). The survey estimating daily maternal engagement was administered in two Level III NICUs and one Level IV NICU at study enrollment, at least 2 weeks after admission. Mothers then completed the daily time use diaries until infant discharge. Data were also collected from participants’ EHRs, charted by nursing staff. Wilcoxon signed-rank tests were used for pairwise analysis of the three measures for maternal engagement activities. Results A total of 146 participants had data across all three measurement types and were included in the analysis. In the Level III NICUs (n = 101), EHR data showed significantly more time spent with all engagement activities than the diary data. In the Level IV data, only differences in time holding were significant when comparing EHR data with survey data, with mothers reporting more time doing KC and less time blanket holding. Comparison of EHR data with diary data showed more time in all activities except KC. Discussion: In most cases, time spent in engagement activities measured in the EHR was higher than in the surveys or time use diaries. Accuracy of measurements could not be determined because of limitations in data collection, and there is no gold standard for comparison. Nevertheless, findings contribute to ongoing efforts to develop the most valuable and accurate strategies for measuring maternal engagement—a significant predictor of maternal and infant health