Objective: Women with preterm labor (PTL) experience multiple stressors resulting in mood changes and depression during pregnancy. These stressors also may impact on emotions and functioning after pregnancy. Despite the fact that 20% of pregnant women experience PTL with its associated negative impact, there continues to be a paucity of theoretically-driven studies to promote maternal coping that test the processes through which interventions exert their influence. Results of a recent study included significantly improved maternal coping with PTL for those women who experienced an intervention program guided by self-regulation and control theories (the MOST program). Investigators in prior studies with other populations have identified beliefs in one’s ability to effectively manage a stressful health experience as a mediator of the effect of interventions designed to enhance coping on improved health outcomes. The purpose of this analysis, therefore, was to explore how the MOST intervention program worked to improve maternal outcomes by testing the mediating effects of maternal beliefs on the relationship between the intervention and maternal coping with PTL.
Design: A two-group longitudinal experimental design with random assignment.
Population, Sample, Setting, Years: Women with PTL and fetal gestational age of 19-30 weeks from 2 high-risk perinatal centers were enrolled (1998-2000) (N=99).
Concept or Variables Studied Together or Intervention and Outcome Variables: Maternal beliefs were hypothesized to mediate the effect of the MOST program on maternal outcomes (negative mood state, depression, and problem-solving). Maternal beliefs (belief in one’s ability to manage the PTL experience, specifically the maternal role and PTL symptoms) is a self-report measure that was assessed by the Maternal Beliefs Scale. The MOST informational-behavioral program (independent variable) addressed women’s PTL experiences and removed barriers to coping. MOST activities included a journal “Me and My Baby,” that reinforced the information and markers of growth in self, pregnancy, and baby. Usual care information was provided for those in the comparison condition. The dependent variables of negative mood state and depression were measured with the POMS-BI and maternal report of problem-solving postpartum with the How Parents Problem-Solve Regarding the Care of Their Infants.
Methods: Women received audiotaped MOST or comparison interventions with matching written information at intake, followed by a booster intervention within 2 weeks. Negative mood state, depression and maternal beliefs were measured within 2 weeks after the first intervention. Problem-solving was assessed 3-4 weeks post-infant discharge. Measures were reliable and valid. Procedures outlined by Baron and Kenny (1986) for testing mediators were used to analyze the data. Complete data for the full sample on one of the 2 measures necessary for testing mediation were unavailable, primarily for women who delivered early (n=13). As a result, in order to maintain adequate power (.70) and avoid making a Type II error, the significance level was set at an alpha of .10.
Findings: Significant correlations were established among the variables. Both requirements for a mediator effect on depression and negative mood state during pregnancy, and postpartum problem-solving were met: (a) the hypothesized mediator (maternal beliefs) explained a significant portion of variance in depression, negative mood state, and problem-solving, and (b) the variance in depression, negative mood state, and problem-solving explained by the MOST program was reduced when controlling for maternal beliefs. Although the intervention had primarily direct effects on negative mood state and depression during pregnancy, there was a trend for its effects to be mediated through maternal beliefs. The intervention also had direct effects on problem-solving regarding the care of the infant. Theses effects were mediated through maternal beliefs about the ability to manage PTL symptoms and the maternal role during pregnancy.
Conclusions: There is potential support for the hypothesis that the effects of the MOST intervention were mediated by maternal beliefs. A mediational pattern consistent with that found in similar studies with other populations emerged at time points during and after pregnancy. The strongest support for the mediational model was found with problem-solving for which there was a longer-term temporal precedence. Replication of the study with a larger sample is warranted.
Implications: Although these findings must be viewed with some caution, they are important in light of related literature in other populations and can help inform understanding of the process by which coping interventions positively influence maternal coping with PTL. Discerning how interventions exert their influence on outcomes is critical in planning targeted clinical care, as well as in refining and developing future interventions. Addressing maternal beliefs may potentiate the effect of interventions on improved health outcomes for women with PTL.
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