Paper: Contextualizing Stress in Preterm Birth: Implications for Research (19th International Nursing Research Congress Focusing on Evidence-Based Practice)

Tuesday, 8 July 2008: 1:55 PM

Doris Boutain, PhD, RN , Psychosocial and Community Health, University of Washington, Seattle, WA

Joycelyn Thomas, RN, BSN , Department of Obstetrics and Gynecology, University of Washington, Seattle, WA

Kathleen Paul , Department of Obstetrics and Gynecology, University of Washington, Seattle, WA

Jane Hitti, MD, MPH , Obstetrics & Gynecology, University of Washington, Seattle, WA

Learning Objective 1: state how income status influenced women's accounts about stress.

Learning Objective 2: describe the importance of studying qualitative along with quantitative reports of stress.

Background: Preterm birth (PTB) remains the leading cause of neonatal mortality in the United States. Although PTB is often associated with stress, studies are needed to understand how women view stress. The purpose of this study was to critically explore what women viewed as contributants to their PTB experience.

Sample: White-American (n=75) and African-American (n=20) women residents of King County, WA were enrolled in the study. Most women had a prior pregnancy 1 year before enrollment. White-American women were slightly older (35 ± 6) than African-American women (30 ± 6). African American women had lower median household incomes (22,000) compared with White American women (95,000).

Methods: One home based interview was conducted with each woman and lasted approximately one hour. Women also completed demographic and psychosocial stress questionnaires. Verbatim interview transcripts were analyzed using both content and critical discourse analysis.

Results: The details of women's stress experiences revealed how socioeconomic status constructed accounts. Many women from high income backgrounds discussed stressors associated with changing homes, jobs or other lifestyles changes. Women from low income backgrounds detailed how they had multiple obligations relating to basic needs for self health, housing and care of kin.

Implications: This study describes how women shaped accounts about PTB in light of economic, family and knowledge resource availability. Prior studies of maternal stress rarely analyzed women's accounts of stress within the context of socioeconomic privilege and vulnerability. Although these results appear logical, stress research rarely identifies how the socioeconomic status of high income women shape their views of stress during pregnancy. Attending to all stress accounts reveals the subtle ways stress research can implicitly privilege the most privileged if the details of stress accounts are not analyzed as a study focus.

Funding: National Institute for Child and Human Health Development (NICHD) R01 HD41682-01.

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