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

Liminality in Practice: A Case study in Life Sciences Research

Contemporary health challenges (e.g. diabetes, climate change, antimicrobial resistance) are underpinned by complex interrelationships between behavioral, cultural, social, environmental and biological processes. Current experimental systems are only partially relevant to the problems they investigate, but aspirations to embed interdisciplinary working and community engagement into life scientists’ work inresponse to this partiality have proven difficult in practice. This paper explores one UK university-based life sciences initiative as it seeks to develop modes of working which respond to this complexity. Drawing on ‘liminal hotspots’ as a sensitizing concept, we explore how participating academics articulate complex problems, knowledge-making, interdisciplinary working and community engagement. Our analysis shows they become recurrently ‘trapped’ (institutionally and epistemologically) between fixed/universalized cosmologies of biology/disease, and more contemporary cosmologies in which biology and disease are conceptualized as situated and evolving. Adopting approaches to community organizing based on ‘process pragmatism’ we propose ways in which life scientists might radically reorganise their practice and move beyond current limiting enactments of interdisciplinary and community engaged working. In doing so we claim that the relevance and ‘humanness’ of life scienceresearch will be increased

An Integrative Review: Maternal Engagement in the Neonatal Intensive Care Unit and Health Outcomes for U.S.-Born Preterm Infants and Their Parents

Hospitals and perinatal organizations recognize the importance of family engagement in the neonatal intensive care unit (NICU). The Agency for Healthcare Research and Quality (AHRQ) defines family engagement as “A set of behaviors by patients, family members, and health professionals and a set of organizational policies and procedures that foster both the inclusion of patients and family members as active members of the health care team and collaborative partnerships with providers and provider organizations.” In-unit barriers and facilitators to enhance family engagement are well studied; however, less is known specifically about maternal engagement’s influence in the NICU on the health of infants and mothers, particularly within U.S. social and healthcare contexts. In this integrative review, we examine the relationship between maternal engagement in the NICU and preterm infant and maternal health outcomes within the U.S. Results from the 33 articles that met inclusion criteria indicate that maternal engagement in the NICU is associated with infant outcomes, maternal health-behavior outcomes, maternal mental health outcomes, maternal-child bonding outcomes, and breastfeeding outcomes. Skin-to-skin holding is the most studied maternal engagement activity in the U.S. preterm NICU population. Further research is needed to understand what types of engagement are most salient, how they should be measured, and which immediate outcomes are the best predictors of long-term health and well-being

We Experience What They Experience : Black Nurses\u27 and Community Health Workers\u27 Reflections on Providing Culturally Specific Perinatal Health Care

Black perinatal health workers are part of a tradition of Black people fighting for the well-being of Black communities. The purpose of this article is to better understand the unique experiences of these professionals. Method: Descriptive qualitative research was used to understand Black providers’ experiences in a culturally specific perinatal public health program. A focus group was conducted with seven nurses and community health workers, and thematic analysis was used to analyze the data. Results: Three themes emerged: (a) shared lived experience and parallel process between staff and clients; (b) navigating multiple shifting gazes between clients, public health department, and medical systems; and (c) reproductive justice and community care characterize a culturally informed approach. Discussion: Findings revealed strengths and complexities facing Black nurses and community health workers in their roles. More work is needed in education, practice, and research to better prepare and support nurses and community health workers in culturally specific settings

Approaches to Addressing Social Determinants of Health in the NICU: a Mixed Methods Study

Objective: Examine current approaches to addressing social determinants of health (SDOH) in the NICU and perceived appropriateness of a standardized screening and referral process. Study design: We performed a mixed methods study in two Massachusetts safety-net NICUs. We examined rates that unmet basic needs were assessed and identified among 601 families. We conducted focus groups with NICU staff to understand current methods to assess unmet basic needs and perceived appropriateness of a standardized SDOH screening and referral process. Result: Except employment (89%), other unmet basic needs were infrequently assessed (housing 38%, food/hunger 7%, childcare 3%, transportation 3%, utilities 0.2%). Staff believed: (1) processes to assess SDOH were not standardized and inconsistently performed/documented; (2) addressing SDOH was important; and (3) using a standardized screening and referral process would be feasible. Conclusions: Current NICU assessment of SDOH is limited and use of a standardized screening and referral process could be useful

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

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

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

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

PERSPECTIVES ON SOCIAL WORK VOLUME 11 (FALL 2015)

This is the full-text volume of Perspectives on Social Work, vol. 11 (Fall 2015)