Dissertations / Theses on the topic 'Maternal wellbeing'

Thesis advisor: Summer S. Hawkins
Preventing poor health in childhood is a national social work and public health priority in the United States. Importantly, child health and wellbeing is explicitly linked with maternal health. Thus, maternal depression, a common mental illness, is a concern not only for the mother, but for the health of her offspring. The purpose of this three-paper dissertation was to extend the understanding of child health and wellbeing at age 9 years old in the context of maternal depression. Analyses utilized data from the Fragile Families and Child Wellbeing study and were guided by a resilience perspective, life course perspective, family systems theory, and ecological systems theory. Paper 1 examined the unique impact of maternal depression on child physical health outcomes utilizing a series of logistic regression analyses. Findings indicated that multiple individual-, maternal-, and family-level risk and protective factors influenced the association between maternal depression and child physical health. Paper 2 utilized latent profile analysis and multinomial logistic regression analyses to examine child physical health and psychosocial wellbeing in the context of maternal depression. Five distinct profiles of child health and wellbeing were identified, suggesting the traditional dichotomy of healthy versus unhealthy may fail to capture the complex nature of child health and wellbeing for those experiencing maternal depression. Results showed that maternal depression was associated with increased risk of poor health and wellbeing, yet also emphasized the ability for children to achieve resilient functioning. Paper 3 explored the impact of maternal depression on the maternal-child relationship and the protective nature of interpersonal supports and community resources. Findings indicated that interpersonal and community resources directly and indirectly supported a positive maternal-child relationship for mothers with depression. Altogether, results extend the literature base by providing a more nuanced and complete examination of child health and wellbeing in the context of maternal depression, with a focus on the potential for resilient functioning among this at-risk population. Findings provide evidence that even in the context of risk, protective factors exist that support resilient functioning. Results have important policy and practical implications, including continued screenings for maternal depression in a primary care setting
Thesis (PhD) — Boston College, 2017
Submitted to: Boston College. Graduate School of Social Work
Discipline: Social Work

While there is a well-established relationship between maternal mental health and infant temperament, few studies have been able to differentiate the unique contribution of exposures occurring in pregnancy from those occurring postnatally. This study draws on data from a prospective longitudinal cohort study conducted in Melbourne, Australia. The Mercy Pregnancy and Emotional Wellbeing Study (MPEWS) is a cohort of 282 participants with measures of maternal depression and anxiety obtained in the first and third trimester, and 6 months postpartum using the EPDS and STAI. Mothers also assessed their infants at 6 months using the Short Temperament Scale for Infants. Regression analysis assessed the contribution of pre and postnatal maternal mental health on infant temperament outcomes indicative of difficulties in emotional and behavioural regulation while controlling for a number of covariates. Results showed withdrawn temperament was predicted by all pre and postnatal measures of maternal depression and anxiety. Postnatal depression symptoms were found to uniquely predict the presence of regulation difficulties and uncooperative temperament, while low birth weight was also identified as a risk factor for regulatory difficulties. Irritable infant temperament was predicted by both pre and postnatal depression and anxiety symptoms, with maternal education mediating this relationship. No associations were found between maternal mental health and reactive temperament, despite a significant negative relationship found with maternal education and income. These results may be attributed to both prenatal biological mechanisms including fetal programming and postnatal factors such as the rearing environment. Future research should aim to build on these findings using a multimethod approach to further understand the mechanisms involved in temperament development for the purpose of designing targeted interventions.

Prenatal diagnosis testing, whether a woman chooses to terminate her pregnancy or carry to term after an adverse prenatal diagnosis, comes with long term, complex implications which include psychiatric, emotional and social problems (Black & Sandelowski, 2010; Fonseca, Nazare & Canavarro, 2012; Howard, 2006, Korenromp, Christiaens, Bout, Mulder, Hunfeld & Bilardo, 2005; Lathrop & VandeVuss, 2011a; Taylor, 1998). A variety of strategies are utilised by professionals to support women prior to the decision-making process, at the point of decision-making and after the termination or birth following an adverse prenatal diagnosis. Understanding the impact of specific types of support has been limited. Additionally, it appears that attempts to develop regulatory standards and models for adequate psychosocial support have failed to date (Abramsky, 2003; Howard, 2006; Shiloh, 1996). This study focused on the impacts of particular types of support (counselling, case management, support groups, friends/family and/or written resources) on the anxiety, guilt and decisional conflict of women after a prenatal diagnosis.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Human Services and Social Work
Griffith Health
Full Text

Understanding the psychosocial predictors of the mother-infant relationship may provide important information to explain the variation in interaction quality observed between dyads. This research examined specific psychosocial predictors of maternal emotional availability (EA): maternal depression and trauma. In addition, the maternal psychosocial predictors of pacifier use during a mother-infant interaction were investigated. Data for the three empirical studies was drawn from 210 women recruited in early pregnancy until six-months postpartum within an Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study. Women video-recorded interacting with their infants at six months postpartum were included, with the quality of their interactions assessed using the EA Scales (EAS). Depression was measured symptomatically and diagnostically at three time points from early pregnancy to six-months postpartum. Maternal trauma was specified as childhood trauma, childbirth experience and also included stressful life events. Observational data regarding pacifier use was collected by the viewing of each interaction, with the fourth translational study including a systematic review of the EA literature to facilitate integration of the EAS into clinical practice. First, results showed a small negative association between antenatal depressive symptoms and maternal EA. Second, moderate to severe childhood trauma and current stressful life events were negatively associated with maternal EA. Third, maternal EA status was associated with pacifier use during the mother-infant interaction. This dissertation highlights that beyond women with depression or trauma, there are other women experiencing reduced EA at six months postpartum. Given maternal EA could be a protective factor for both child outcomes, and the future mother-child relationship, consideration of integrating the EAS into a clinical setting should be explored.

Parental time pressure, in terms of actual workload and subjective reports, is high and likely to increase in the future, with ongoing implications for personal wellbeing. The combination of parenting young children and maternal employment, in particular, gives rise to greater time pressure in families. Although characterised by increasing diversity, two of the most time pressured family types, dual-earner and lone parent families are central features in the Australian demographic landscape. In view of predominant social and cultural trends, the ‘problem’ of time pressure is deep-rooted and set to grow. While the need to address ‘work-family balance’ is prominent in political and social life, the relationship between time pressure and wellbeing has not been well quantified and we know little about how that relationship works in families. At the heart of the time pressure problem, is a potential threat to the healthy development of children. This thesis, then, is broadly concerned with the nature of time pressure and its relationship with parental wellbeing when they are caring for young children.The central aim of the thesis is to determine whether time pressure has a significant impact on the self-reported wellbeing of parents with young children. There are four main research questions. Time pressure is defined as being both objective (‘parental time use’) and subjective in nature (‘parental perceptions about their time’). The questions are: (1) What is the relationship between parental time use and parental perceptions about their time? (2) How do parental time use and parental perceptions about their time relate to their self-reported wellbeing? (3) Are the effects of parental time use and parental perceptions about their time on self-reported wellbeing modified by other perceived stressors and psychological coping resources? (4) What are the predictors of self-perceived time pressure? Because of their broad scope, each of these questions is given further focus by the stating of specific sub-components.The study draws from several selected theoretical perspectives and models around the influence of time on individual health and wellbeing. Because the experience of time pressure has multiple interacting levels of influence from the individual through to family, work, and community settings and more widely from the social, political and cultural environment, the thesis is underpinned by ecological theory. To allow for the meaningful and practical measurement of time pressure within different contexts, the Family and Community Resource Framework was adopted. The Framework views time as a resource that can be utilized and traded by families with other resources of human, financial, psychological and social capital to enable family functioning and individual wellbeing. Then, to make sense of the pathways of influence, subjective time pressure was conceptualized as a psychosocial factor within an epidemiological model of the social determinants of health. These theoretical perspectives in combination are woven throughout the thesis as both a guide and a means of interpreting results.In addressing the broad research gaps around time pressure and parental wellbeing, the study took a population perspective and a quantitative methodological approach. A sub sample of parents with young children (at least one resident child aged less than six) was drawn from Wave Two of the Household Income and Labor Dynamics of Australia (HILDA) Study, conducted in 2002. Acknowledging the key role of gender and employment status in the experience of time pressure, all analysis was undertaken separately for employed mothers (n=451), non-employed mothers (n=512) and employed fathers (n=686). At another level that recognizes the influence of family structure and joint employment arrangements, analysis was undertaken for parents in ‘dual-earner families’ (n=346), ‘traditional families’ (n=321) and ‘lone mother families’ (n=145). This approach addressed the specific deficiency of quantitative studies of time pressure (objective and subjective) among families at the population level.The concepts of “parental wellbeing”, “parental time use”, and “parental perceptions about their time” were all operationalized by a set of self-reported measures. Parental wellbeing was captured by the mental health, vitality and general health subscales of the MOS-Short-Form 36 allowing for variation in positive health states. Parental time use (objective time pressure) was measured by their self-reported estimates of average weekly hours in paid work, household work (sum of indoor and outdoor activities, and chores) and of their time spent with children. Furthermore, these three estimates were summed to provide two measures of total workload. Parental time perceptions (subjective time pressure) were quantified by questions about their paid work hour preferences and satisfaction, perceived fairness in their share of housework and childcare, satisfaction with their amount of free time, and primarily by their self-perceived time pressure. The study also drew on indicators of job quality, financial wellbeing, parenting stress and perceived social support to examine the modifying role of other psychological resources on the relationship between time pressure and wellbeing. The bulk of analyses utilized multivariate linear regression techniques to examine the simultaneous effects of time use and parental perceptions about their time on mental health, general health and vitality, with adjustment for family characteristics and indicators of human and financial capital.Primarily, the thesis concludes that time pressure has a significant negative impact on the wellbeing of many Australian parents with young children, in particular, when they are employed. ‘Self-perceived time pressure’ proves to be a complex issue as high levels were associated with large amounts of paid work and household work; with perceptions of unfairness in household work and childcare; with low free time satisfaction; with higher levels of job and parenting stress, and lower levels of perceived social support. The thesis provides conclusive evidence that a high level of self-perceived time pressure lowers the mental health, vitality and general health of all parents. For employed parents, low levels of satisfaction with their paid work hours, and for all parents, low levels of satisfaction with their free time hours had an additional detrimental effect on their mental health and vitality. In contrast, there was little evidence overall that parental distribution of time to specific activities, or that a greater total workload independently contributed to lower wellbeing. Unpredictably, employed mothers had better wellbeing when they spent a relatively large amount of time with their children. Furthermore, a high level of self-perceived time pressure exerted a detrimental effect on the wellbeing of some employed parents even after adjustment for other reported stressors around work and family life. Additionally, there was evidence that among the most highly time pressured mothers a higher level of perceived social support did little to buffer the impact of time pressure on aspects of their wellbeing. Integral to the findings is the evidence that family employment arrangements and structure alter the meaning of time pressure and its relationship to parental wellbeing.These conclusions raise the question of how to avoid time-pressured circumstances in Australian families, and how to support and resource parents who are already feeling chronically pressed for time. The very nature of time pressure implies multiple levels and points of intervention at the policy, community, workplace, family and individual level. Avoiding time pressure in families requires continued policy directions aimed at creating flexibility and choice in how parents divide their time between work and family with safeguards against excessive hours in paid work. Furthermore, the findings prompt the need for an expanded policy to one that includes leisure or time for oneself and the facilitation of parental time with children. From a preventive perspective, specific and early intervention at a family level from pre-conception through to antenatal and early parenting programs will help to facilitate a gender equitable approach to the division of labour. Among employed parents, correlations between self-perceived time pressure and their perceived stress and complexity of paid work suggest a greater role for workplaces in preventing and identifying psychosocial stress among employees. Inherently more difficult is identifying and supporting parents who are already feeling the strain. The prevalence of perceived time pressures and the strong negative association with parental wellbeing suggests the need for a public health response. The urgency for action lays in the potential damage to the relationship between the parent and developing child. Fundamentally, all strategies should be aimed at giving parents back a sense of control over their time.The thesis lays a foundation for ongoing research examining the effects of paid and unpaid work patterns, free time and perceived time pressures on parental, child and family wellbeing over time.

Paternal support is often linked to lower levels of maternal distress. However, this link is less established among the increasing numbers of Mexican-American families with a romantic partner social (RPS) father, that is, mothers' partners who are not formally identified as stepfathers. This study applied a bioecological systems framework to test linkages between RPS father support and maternal depression and parenting stress above and beyond ecological stressors, and to consider whether nonresident biological father support and general instrumental support moderate this link. Using data from the Fragile Families and Child Wellbeing Study, we analyze a subsample of Mexican-American mothers (N = 76) with three-year-olds, who are involved in a relationship with a RPS father and maintain contact with the nonresident biological father. Findings indicate that mothers who reported greater support from RPS fathers also reported lower depressive symptomatology when they also reported greater support from nonresident biological fathers or reported being in a recent relationship with the RPS father; mothers from more established relationships reported more depressive symptoms. However, mothers with lower perceived instrumental social support reported high maternal depressive symptoms, even while receiving support from RPS fathers. Neither source of support significantly predicted maternal parenting stress. Overall, our results reveal complex, interactive associations between these combined sources of support and maternal mental health in these increasingly common family structures.

Thesis advisor: Margaret Lombe
For children that overcome Nigeria’s high child mortality rate, there is the additional and less-obvious hurdle of not reaching their full potential in life due to developmental delays. When children are on track developmentally, they stand a better chance of being ready for school, excelling academically, economically, and socially throughout the lifespan. Fewer studies in the Nigerian context have examined how known risk and protective factors interact to affect early childhood development (ECD). This three-paper dissertation used data from the nationally representative 2016/17 Multiple Indicator Cluster Surveys (MICS) and was guided by the social determinants of health framework, the socioecological model of child development, and the family stress and investment models. The study highlighted the factors, including disparities across the multiethnic and diverse socioeconomic groups of Nigeria that are associated with child outcomes. i. Paper 1 assessed the performance and psychometric properties of the 10-item ECDI used in the MICS to track developmental outcomes among Nigerian children. ii. Paper 2 characterized the risk and protective factors for ECD across the 36 states and FCT of Nigeria using a multilevel modeling approach and, iii. Paper 3 used a structural regression to model the association between maternal subjective wellbeing (SWB), and developmental outcomes among the 3- to 4-year-old children. Findings highlighted discrepancies in the construct validity of the ECDI. Across the studies, resources, and family socioeconomic status particularly maternal level of education were significant predictors of outcomes for the child. Further, the study revealed that a child’s developmental context matters, where 29% of the variation in child outcomes was attributed to clustering by states. The studies extend prior research on ECD in Nigeria by its use of more accurate milestones to characterize ECD, its multilevel modeling approach, and its investigation of maternal SWB as a proxy for mental health. In all, findings from the dissertation call attention to the need to revise the ECDI, and for culturally adapted and validated ECD instruments. The study also highlighted the need to invest more resources in child development, mental health, and family strengthening especially through maternal education and wealth creation
Thesis (PhD) — Boston College, 2020
Submitted to: Boston College. Graduate School of Social Work
Discipline: Social Work

This thesis contains three chapters that each study the spillover effects of two aspects of the child's household environment, Domestic Violence (chapter one and two) and Maternal Working Hours (chapter three). The first chapter looks at Children's Health, the second at Education Outcomes and the third looks at children's Well-Being. Understanding what influences a child's early development is of paramount importance as it explains future job market performance and success in life in general. All chapters exploit the data set UK Millennium Cohort Study (MCS), a longitudinal survey following around 19,000 children born in the UK in 2000-01. The first chapter studies the effect of Domestic Violence on children's health production function. We use waves 4 and 5 of the MCS, when children are aged 7 and 11, respectively. We find that there is a strong negative externality of living in a household where there is violence on children's parental-assessed health outcomes. Simultaneity between the child's health and the existence of Domestic Violence in the household makes it diffcult to establish a causal relationship, so we use an instrumental approach to address the potential bias caused by this. In particular, our results show that children exposed to Domestic Violence appear to be between 55% and 61% less likely to have their health rated as Excellent. Our results are robust and statistically significant across all specifications. Our paper not only sheds light on the negative impact of Domestic Violence on children's health but provides a robust quantification of this effect. This chapter is co-authored with Prof. Jofre-Bonet and Dr. Serra-Sastre. The second chapter studies the spillover effect on children's educational attainment of living in a household in which mothers are subject to Domestic Violence. To do so, we exploit measurements of the child's educational performance in English, Science, Mathematics, Physical Education, Creativity, and Information and Technology by the age of 7 and 11, available in the MCS. Our results suggest that growing up in a household where there is Domestic Violence has a negative impact on all educational outcomes. Our results are robust and hold when addressing several potential sources of sample selection bias. Children from domestically abused mothers lose around 0.20 standard deviations in English and 0.30 standard deviations in Mathematics scores at an age as early as 11 years. The cumulative negative effect is heterogenous across academic areas, being more pronounced for those subjects where past knowledge acquisition is essential (i.e., Mathematics and Science). This chapter is co-authored with Prof. Jofre-Bonet and Dr. Serra-Sastre. The third chapter investigates how maternal working status is connected to children's well-being at ages 7 and 11. The rapid increase of female participation in the labour market, along with the impact that well-being levels during childhood has on their psychological development and labour market outcomes later in adulthood, calls for a closer examination of this topic. To do so, we also exploit the MCS, which contains a very complete set of children's well-being outcomes and the intensity of the engagement of mothers with the labour market. To our knowledge, this is the first paper to use such a full array of children's well-being indicators and relate it to maternal labour supply. Our results show that in households in which mothers work fulltime, children are, on average, happier, less worried, as well as less likely to lose their temper. Further, we investigate whether child obesity, which has been related to children's well-being, is associated to the mother's working hours, the mother's commuting time and the father's employment status. We find that higher the number of working hours of the mother increases the likelihood of the child being obese at 7 and 11 years of age, in line with previous literature. This chapter is co-authored with Prof. Jofre-Bonet and Dr. Serra-Sastre.

During the latest decade Somali-born women with experiences of long-lasting war followed by migration have increasingly encountered Swedish maternity care, where antenatal care midwives are assigned to ask questions about exposure to violence. The overall aim in this thesis was to gain deeper understanding of Somali-born women’s wellbeing and needs during the parallel transitions of migration to Sweden and childbearing, focusing on maternity healthcare encounters and violence. Data were obtained from medical records (paper I), qualitative interviews with Somali-born women (II, III) and Swedish antenatal care midwives (IV). Descriptive statistics and thematic analysis were used. Compared to pregnancies of Swedish-born women, Somali-born women’s pregnancies demonstrated later booking and less visits to antenatal care, more maternal morbidity but less psychiatric treatment, less medical pain relief during delivery and more emergency caesarean sections and small-for-gestational-age infants (I). Political violence with broken societal structures before migration contributed to up-rootedness, limited healthcare and absent state-based support to women subjected to violence, which reinforced reliance on social networks, own endurance and faith in Somalia (II). After migration, sources of wellbeing were a pragmatic “moving-on” approach including faith and motherhood, combined with social coherence. Lawful rights for women were appreciated but could concurrently risk creating power tensions in partner relationships. Generally, the Somali-born women associated the midwife more with providing medical care than with overall wellbeing or concerns about violence, but new societal resources were parallel incorporated with known resources (III). Midwives strived for woman-centered approaches beyond ethnicity and culture in care encounters, with language, social gaps and divergent views on violence as potential barriers in violence inquiry. Somali-born women’s strength and contentment were highlighted, and ongoing violence seldom encountered according to the midwives experiences (IV). Pragmatism including “moving on” combined with support from family and social networks, indicate capability to cope with violence and migration-related stress. However, this must be balanced against potential unspoken needs at individual level in care encounters.With trustful relationships, optimized interaction and networking with local Somali communities and across professions, the antenatal midwife can have a “bridging-function” in balancing between dual societies and contribute to healthy transitions in the new society.

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Admission of infants to school is the period of transition from care provided by the family system to care provided by the school system. It demands adaptation not only of the child, who is expected to interact with strangers in an unknown environment with new routines, but also of the family and the school because it requires reorganizations and transformations for all of them. The overall purpose of this study was to develop both a protocol, which aims to systematize the process of school admission of infants, and an explanatory folder as teaching tools. As specific objectives, the study aimed at the following: subsidizing the adherence of families to school as participants in the educational process; facilitating the admission process of infants from twelve to twenty-four months of age in a Centre for Early Childhood Education; verifying the relationship between maternal wellbeing and personality in the mothers’ and teachers’ perceptions regarding the adaption process of the infants to the school system; and analyzing the stability of two variables, which are “depressive symptoms” and “life satisfaction”. The study was based on a systematic literature review which focused on the relationships between the mothers' subjective wellbeing and the variations of child development. Furthermore, the link among life satisfaction, depressive symptoms and personality traits was analyzed through an empirical longitudinal study. It was developed between March and December of 2016 and investigated two educators and nine mothers of babies who joined a Centre for Early Childhood Education in the central region of the state of Rio Grande do Sul in the same year. Results found in previous studies have revealed the great influence of maternal wellbeing in the first years of a child’s life and the need to qualify the care provided to infants and young children in kindergartens and similar institutions. As a result, a protocol was organized to systematize the admission process of infants as well as an explanatory folder to be distributed in the Centre. Despite the extraordinary growth in Psychology studies on maternal health and child development, it has been found that the majority of them focus on the investigation of the symptoms and their effects, that is, they are based on the Traditional Psychology of a posteriori intervention. Therefore, this topic requires more studies of typical development, which aims at preventing misadjustments on behalf of children and their parents in order to increase subjective wellbeing, thus maximizing strengths and virtues of mothers or caregivers.
Inserção de bebês na escola é um período de transição dos cuidados prestados pelo sistema familiar para o sistema escolar. Exige adaptações não apenas da criança, que passa a conviver com pessoas estranhas em um ambiente desconhecido, com novas rotinas, mas também da família e da escola, pois, implica em reorganizações e transformações para todos. O presente trabalho teve como objetivo geral desenvolver como ferramentas pedagógicas um protocolo de sistematização do processo de inserção escolar de bebês e um folder informativo. Como objetivos específicos, o estudo visou: subsidiar a adesão das famílias à escola como participantes do processo educacional; facilitar o processo de inserção de crianças de doze a vinte e quatro meses, no Centro de Educação Infantil; analisar a relação entre bem-estar materno e sua personalidade; verificar a percepção das mães e professoras, quanto ao processo de adaptação dos bebês ao sistema; analisar a estabilidade das variáveis ‘sintomas depressivos’ e ‘satisfação de vida’. Partiu-se de revisão sistemática de literatura sobre as relações entre bem-estar subjetivo das mães e variações de desenvolvimento infantil. Após, foi realizado um estudo empírico, longitudinal e verificou-se a relação entre satisfação de vida, sintomas depressivos e traços de personalidade com a adaptação de bebês. A coleta de dados se deu de março a dezembro de 2016, e contou com a participação de duas (2) educadoras e nove (9) mães de bebês que ingressaram em 2016, em um Centro de Educação Infantil da região central do Rio Grande do Sul. Os resultados indicaram a grande influência do bem-estar materno nos primeiros anos de vida e a necessidade de qualificação do atendimento prestado aos bebês e crianças pequenas em creches e instituições similares. Em vista disso, organizou-se um protocolo de sistematização do processo de inserção escolar de bebês e material informativo em formato de folder, para distribuição na instituição. Apesar do exponencial aumento de estudos na área da Psicologia sobre saúde materna e desenvolvimento infantil, percebeu-se que a maioria deles visa a investigar os sintomas e seus efeitos, ou seja, estão baseados na Psicologia Tradicional de intervenção à posteriori. Logo, destaca-se a necessidade de mais estudos envolvendo o desenvolvimento típico que busque a prevenção de desajustes em crianças e seus familiares, para a melhoria do Bem-estar subjetivo, potencializando forças e virtudes das mães ou cuidadores.

Factors influencing adjustments in the transition to parenthood are identified and strategies for support in Britain and the USA are reviewed through participant-observation of 20 USA programmes (N=94 parents). A longitudinal British study, using a wide range of self report measures and in-depth interviews at three time points (1) examined key features of the transition to parenthood for a low risk sample of women (N=106) and men (N=106), and compared adjustments of 52 couples who participated in a new support programme with 54 couples who did not. The programme combined a group-based and home visit model which either began in pregnancy and continued postnatally, or began postnatally. The programme focused on the psychological dimensions of the transition to parenthood, with the intersubjectivity of the couple and parent-infant relationship at the core of the integrative model. Evidence is provided that the transition to parenthood is more complex than previous studies assume. A substantial number of the "low risk" women and men appeared to experience psychological distress and the main concern of women and men were different from the agenda of hospital based antenatal classes. A number of gender differences were found but partners were the main source of support for women and men. Women and men in the support group were comfortable to disclose explicit details about their experiences. At 6 months postnatally, their adjustments were more positive than women and men on the control for aspects of (a) confidence as a parent; (b) satisfaction with the couple relationship ; (c) satisfaction with the parent-infant relationship; (d) coping strategies, and (e) separation anxiety. Implications for theory, research and practice are discussed.

Potential influences from using sexually explicit Internet material (SEIM) are controversial, however, the underlying psychological mechanism(s), which potentially can explain these found associations with SEIM consumption, have not been well studied. In the present research, I examine the relationship between SEIM consumption and subjective wellbeing (i.e., sexual and general wellbeing). In particular, I address the circumstances under which the consumption of SEIM is negative for wellbeing by assessing an ideal-actual sexual discrepancy in the context of intimate relationships. I drew on perspectives from self-discrepancy theory to explore whether SEIM consumption generates disparities between ideal and actual sexual experiences, which then may influence consumers’ sexual and general wellbeing. I expected this hypothesized ideal-actual sexual discrepancy to function as one of many underlying psychological mechanisms to explain SEIM’s negative impacts on various types of subjective sexual wellbeing (SSW). I also expected that via SSW, the discrepancy would also explain the ambiguous relationships between SEIM consumption and subjective general wellbeing (SGW) found in the past. That is, I predicted a serial mediation model with sexual self-discrepancy mediating the relationship between SEIM consumption and SSW, and SSW mediating the relationship between sexual self-discrepancy and SGW. Two studies together demonstrated the general progress from consuming SEIM to the evaluation of self-perceived wellbeing under the condition of evaluating sexual experiences with intimate partner(s). In Study 1, the data-driven gender specific sexual preference highlighted the need of model testing separately for men and women because of the potential difference in experiencing the negative impacts from consuming SEIM through the different progress of formation of ideal sex scripts influence by pornographic sex, and generation of an I-A sexual discrepancy in men and women. Results of Study 2 from male SEIM consumers further supported the hypothesized mediation role of I-A sexual discrepancy and SSW (i.e., sexual esteem and sexual satisfaction) in understanding the relationships between SEIM consumption and wellbeing. Overall, the present research illustrated the consumption of SEIM can shape one’s sexual preferences of pornographic sex and generate unrealistic expectations of pornographic sexual experiences with intimate partner(s). Hence, the experience of I-A sexual discrepancy from unachievable ideal sex is a key factor in identifying SEIM’s negative impacts on wellbeing. Moreover, parsimonious serial mediation paths through I-A sexual discrepancy and SSW also demonstrated the relationship between SEIM consumption, SSW, and SGW in one model. This finding indicates SSW works as an important indicator of ones’ SGW. The present research provides a theoretical explanation to understand the impact of consuming SEIM on wellbeing and implicates the importance exploring different types of sexual discrepancy associated with SEIM consumption and ways to mitigate the experienced I-A sexual discrepancy in intimate relationships.

The human heel pad is subject to repetitive loading and plays an important role in absorbing shocks which may cause injuries. The heel pad has a composite biological structure consisting of the fat pad and the skin. The fat pad tissue is organised into a superficial micro-chamber layer and a deep macro-chamber layer. The heel pad sub-layers have different structures and properties. Hence, to understand the contribution of each layer to the heel problem, it is essential to develop a model with discrete structure. Currently, only plantar pressure measurements are used for diagnosis and treatment of the heel problems, whereas it has been shown that high internal tissue stress is an important factor. Because of complex geometry, discrete structure and nonlinear material behaviour of the heel pad, the external force applied to the heel may result in inhomogeneous internal stress condition. Therefore, the relationship between the plantar pressure and internal stress does not seem to be simple. Since there is no equipment to allow measurement of internal stress, a detailed multi-layered FE model of the heel pad can be used as a solution to predict the internal stress. The main objective of this work was to obtain the hyperelastic and viscoelastic material properties of the subject-specific heel pad sub-layers in-vivo. For this purpose, a combined methodology of finite element modeling and experimentation was developed. An anatomically detailed 3D FE model of the human heel area was developed using MR images of the right foot of a female subject. A combined ultrasound and indentation system was used to apply series of slow and rapid compression tests on the same foot. The forcestrain responses of the heel pad and its sub-layers were used as input to the FE model to estimate properties of the heel pad sub-layers using inverse FEA. The hyperelastic and viscoelastic FE models were then implemented to investigate the effects of experimental and geometrical factors on the heel pad responses. The model was also used to assess the robustness of the hyperelastic FE model when predicting the behaviour of other heels with different geometries. Finally, this model was used with Taguchi method to evaluate the effect of footwear design factors on the compressive stress in the heel pad tissue. There were some key limitations in this study. For example, the properties of the heel pad sub-layers were estimated only for a specific heel pad. Also, whilst it is preferred to use xviii automatic segmentation and solid modeling to improve repeatability of some FE processes, some parts of the modeling process were performed manually.

This paper seeks to review the national disaster plans of Jamaica from the perspective of child protection and wellbeing in emergencies. The focus of the review is on needs associated with education, psychosocial support and family reunification (including care of unaccompanied and separated children) as these needs are often given less priority in an emergency. These are referred to collectively as the non-material needs of children in emergencies. Providing for the non-material needs of children in emergencies is an important part of preventing children from experiencing physical or sexual abuse, psychological distress, neglect and harm and it is therefore vital that these are not an afterthought but an integral part of planning for an emergency. In order to review these plans a tool in the form of a checklist of measures of international standards was compiled and applied to the plans. This paper finds that the national disaster plans of Jamaica fail to meet every measure on the compiled checklist. Children are not even mentioned as a vulnerable group in need of special attention nor are measures defined to prevent them from long-term or short term harm. The limited or non-existent extent to which children are considered is furthermore found to be an issue in national disaster planning of other states. This paper therefore recommends that the national disaster plans of Jamaica, as well as other states, be revised in partnership with local stakeholders (including children, the ultimate stakeholders) taking into consideration the findings presented.

Quilting is a self-chosen leisure activity for millions of women in the United States. Previous research on quilting suggested that quilting is influenced by the emotional state of the quilter. However, the emotional experiences generated during quilting have not been fully explored. The purpose of this qualitative narrative study was to explore quilters' perceptions of what quilting as a leisure activity does to enhance their well-being and increase flourishing. Positive psychology well-being theory was the theoretical foundation for the study. Semistructured interviews with 12 adult women who quilt as a leisure activity were the basis of the narrative inquiry. Data were recorded through in-person and telephone interviews that were transcribed and analyzed using thematic analysis to develop overarching themes. Findings revealed that quilting contributed to participants' well-being and built flourishing through three primary avenues: creativity, relationships, and positive emotion. Quilting provided an opportunity for creative expression and growth as artists. Quilt-making activity was centered around relationships with other quilters and with the larger community, and quilting was linked with positive emotion as participants experienced great joy in their quilting activities. This study has implications for increasing well-being and building flourishing in women through the adoption of quilting as a leisure activity.

Preterm birth (<37 weeks of gestation) impacts approximately 11.1% of births worldwide, each year (World Health Organization, 2018). Despite extensive research on psychopathology after preterm birth, there is limited research adopting a strengths-based framework evaluating adaptive outcomes. This cross-sectional study aimed to investigate wellbeing and posttraumatic growth in birthing parents of children aged 0 – 9 years, and identify risk and protective factors associated with outcomes. Participants were recruited and completed the study questionnaire online including the Psychological Wellbeing Scale (Ryff & Keyes, 1995) and Posttraumatic Growth Inventory (Tedeschi & Calhoun, 1996). The final sample included 866 birthing parents (n=861 female gender) of children born preterm in infancy-toddlerhood (n=308), early (n=259), and middle childhood (n=299). Results indicated a positive association (p<.001) between wellbeing and posttraumatic growth, and differences in outcomes by child age groups. Caregivers of children in early childhood reported lower wellbeing and posttraumatic growth than those in infancy-toddlerhood and middle childhood. Differential child and sociodemographic risk factors for wellbeing and posttraumatic growth were identified. Findings provide insight into age-related differences in cognitive and affective processes, and risk factors that can be targeted in the development of postnatal care following preterm birth.

Women’s needs after childbirth are varied and numerous, and the weeks and months following birth are crucial for both mother and baby. Many women experience emotional issues after childbirth, and some of these complications may persist for a prolonged time period. The trickle-down effects of mothers who do not feel mentally well are significant, as reduced mental wellbeing is associated with poor health outcomes for their babies and families. Despite these ramifications, the postnatal period is often ‘eclipsed’ by the attention paid to the antenatal and intrapartum periods, and the health needs of postnatal women are often not addressed in practice or research. While a considerable volume of work has focused on postnatal depression (PND), only 12-14% of women fall into this diagnostic category, and there is a lack of research examining the postnatal mental wellbeing of the remaining majority. Research in a Tasmanian context is particularly scarce. For these reasons, determining how mental wellbeing can be promoted for women in this context is the focus of this study. To gain a better understanding of what influences new mothers’ ability to cope, a longitudinal, phenomenologically-informed study was conducted in northern Tasmania. Purposive sampling was used to recruit 13 first-time mothers, and a series of four in-depth interviews was undertaken with each participant over the course of her first year of motherhood. The interviews were digitally recorded and transcribed verbatim, and then analysed using a modified version of van Manen’s analytic strategy. After analysis, overarching themes from each set of interviews emerged as an illustration of the commonalities in the lived experiences of first-time motherhood in Tasmania. These themes were utilised to gain improved understanding of how mental wellbeing in new mothers can be promoted. The findings of this study suggest that new mothers face challenges in coping, even outside the diagnostic category of PND. Some sources of struggle for these women included learning to breastfeed, adjusting their self-identities to include being a mother, shifting their priorities, and juggling the competing new demands in their lives. Participants also noted a lack of maternal-focused health care once their babies were born. None of the 13 participants in this study were diagnosed with PND, however each of them recounted struggles, emotional lability, and difficult periods as they adapted to their new lives as mothers. Certain influences were shown to mitigate the challenges they experienced, including multiple forms and sources of support, as well as fostering self-efficacy and time for self-care. This study therefore gives voice to the majority of women who do not become clinically depressed in early motherhood, but face struggles as they find a new balance and adapt to life during their first year with a baby. This research articulates the breadth of needs women have over the course of the first year after childbirth from a mental wellbeing perspective, and how these needs change over time. By examining how these needs can be addressed, strategies for promoting mental wellbeing in this population can be developed. An empirically based health promotion model was developed to articulate strategies to promote maternal mental wellbeing for new mothers. Tasmania lacks a comprehensive program of care for women in the postnatal period, and this research can contribute to the development of informed policies to provide improved emotional support to future first-time mothers.

Introduction A group of 317 HIV-1 infected pregnant women and 53 postpartum HIV-negative women were recruited for a two-year prospective descriptive study of psychosocial and other determinants of antenatally planned and actual postnatal feeding, associations between maternal status and infant feeding practices, and health outcomes. Methods The subjects were interviewed periodically for 2 years using structured research instruments. Anthropometric measurements, biomarkers of nutritional status and measurements of pysychosocial wellbeing were obtained from the mothers. Data was collected on infant feeding and outcomes for the babies. Results At recruitment, 74% of mothers planned to formula-feed. Significant differences between these women and those who planned to breastfeed emerged. After delivery, 25% of the women who antenatally planned to formula-feed changed their minds and actually breastfed. Conversely, half of the women who antenatally planned to breastfeed actually formula-fed. Some significant reasons emerged for these feeding changes. Most mothers were well-nourished or overweight. Breastfeeding mothers lost little weight between six weeks and six months after delivery. At the end of follow-up, 65% were obese. While there were differences between HIV-infected and uninfected women in respect of micronutrients, no deficiencies were observed. Vitamin A and selenium concentrations were higher in the HIV-infected women than uninfected women at six weeks. There were no significant micronutrient changes over time. Most mothers maintained an adequate immune status with only slow deterioration of CD4 counts. At two years postpartum, 60% had a CD4 cell count greater than 500cells/mm³, and only about 8% less than 200/mm3. HIV transmission was 15% by 24 months of follow-up. Among the 65 ever breastfed children, 16 (24.6%) were HIV-infected compared to 12.8% of never breastfed children. Most children were growing normally, suggesting that, overall, maternal HIV status did not interfere with feeding ability. Eight mothers (3%) and 33 children (11%) died. Only 12 of 33 children who had died had a positive HIV-PCR. By 2 years, 78% surviving HIV-infected children had been initiated onto ARV therapy. Maternal adherence to HAART was poor. Conclusion HIV and infant feeding counselling is inadequate in the routine PMTCT programme, with stigma and lack of disclosure continuing as major barriers to appropriate care. Whilst maternal obesity was common, most children were growing normally. Weaknesses in routine PMTCT services were identified, and compliance with HAART was poor.
Thesis (PhD)--University of Pretoria, 2010.
Paediatrics and Child Health
unrestricted

This thesis story is about the discursively lived and re-membered experiences of a small number of local, non-indigenous women most of whom are based in the Blue Mountains of New South Wales, Australia. Each of these women grew up with a mother diagnosed 'mad' within the medical model. My subjective experiences are the beginning place of this re-search. Throughout my life with her, my mother was given a variety of diagnoses within the medical model. I wanted to know how other women lived the complexities of this particular mother-daughter relationship. The thesis foregrounds know-ledges and voices that are usually silenced. There is a growing body of work about women and 'madness', about the mothers' experiences, however there is little written that places the daughters in the centre of the text. Using critical social science paradigms and the tools of post-modernism and feminisms, the daughters' stories inter-rupt and dis-rupt the dominant discourses about famil(y)ies, mothering and mental illness. By foregrounding these know-ledges, I hope that some new ways of thinking about - of seeing - these lived discursive experiences will emerge. These stories also have much to say about life's journey. The thesis is about knowing the ledges we traveled along - or didn't. It is also about which know-ledges are heard and which are silenced, who speaks for what purpose - and in this, who and what are necessarily being shadowed. It is about the inter-ruptions and dis-ruptions in know-ledges. At the beginning of each chapter, I have highlighted some prominent inter-ruptions to the discourses within that chapter. I also signpost and begin a tentative discussion of the contribution of 'mad' mothers to post-modernism and feminisms. A contribution, which it seems to me, is not fully ac-know-ledged.

Background: Exposure to passive smoking in childhood, which mainly comes from parents, continues to be a concerning major public health issue many years after comprehensive global action on tobacco control was initiated. This thesis aimed to examine (1) the prevalence, determinants and the trend of maternal smoking during pregnancy; (2) hospital use among children associated with exposure to maternal smoking during pregnancy; (3) validity and reliability of a life course questionnaire on exposure to passive smoking during childhood and (4) the effect of exposure to passive smoke across childhood on cardiovascular function in adulthood. Previous studies in these areas had limitations related to measurement of exposure or outcomes, were cross-sectional, or did not have objectively measured outcomes. This thesis sought to overcome these limitations, adding new information in these areas that could be important for public health policy and practice. Methods: Participants were drawn from three datasets, Tasmanian Conception to Community study (C2C), Childhood Determinants of Adult Health Study (CDAH) and Tasmanian Infant Health Study (THIS). C2C is a de-identified linked dataset comprising perinatal, emergency department, and admitted patient databases collected between the period July 2008 to June 2014. Data on maternal smoking during pregnancy and other study factors were self-reported by mothers and collected by midwives as part of nationally mandated perinatal datasets. Emergency department presentations and admission into hospital through ED were from public emergency department data. The CDAH study comprised of the 1985 Australian Schools Health and Fitness Survey (ASHFS) cohort aged 7- 15 years that were subsequently followed up in CDAH-1 (2004-06), CDAH-2 (2009-11) and CDAH-3 (2014 - 19). A range of validated measures of cardiovascular structure and function were assessed by trained data collectors at face-to-face clinics around Australia. Data on passive smoking during childhood was collected with questionnaires in childhood and adulthood. The TIHS included birth cohort between January 1988 to March 1990 that was followed up in 2015-16 for a pilot study of adult cardiovascular health. Measures of cardiovascular structure and function were taken in face-to-face clinics. Exposure to passive smoking during pregnancy and childhood was self-reported by mothers prospectively around the time of birth and shortly after. Results: The first study examined the trends and determinants of maternal smoking during pregnancy, changes in maternal smoking during pregnancy between and within pregnancies and their determinants in Tasmania, Australia. Maternal smoking during pregnancy declined from 25.9% (2008) to 16.4% (2014). A cessation proportion of 35.1% was observed between index (first birth recorded in the dataset) and last pregnancy. Maternal alcohol consumption during pregnancy, living in a highly socioeconomically disadvantaged area or being an Aboriginal or Torres Strait Islander was associated with an increase in the prevalence of maternal smoking during pregnancy and continued smoking between pregnancies. The second study evaluated the effect of exposure to passive smoking during pregnancy on ED presentations and admission into hospital through ED in exposed children up to 1-year and 5- years of age. Exposed children had 26% and 45% higher overall presentation to ED and admission into hospital through ED, respectively, compared to unexposed children at 5 years of age. Higher presentation and admission for respiratory, eye, ear, nose, and throat illnesses, systemic and parasitic infections and psychosocial/other presentations were observed above the level of the negative control outcome of poisoning or injuries in exposed children at 5 years. Similar results were obtained at 1 year. These effects had a dose-response relationship with increased rates of presentation and admission associated with higher exposure to cigarettes per day. The third study examined the reliability and validity of a retrospective questionnaire administered to middle-aged adults in CDAH phase 3 on prolonged exposure to tobacco smoke across childhood. The three measures of passive smoking derived from questions on other people smoking in the home (example. parents and siblings) included total household smoker (range: 0 to 5 smokers); cumulative years of exposure (range: 0 to 106 years) and severity of exposure index (range: 0 to 318). The three retrospective measures had good internal consistency and moderate agreement with childhood and adulthood factors in ASHFS and CDAH. The three measures were also significantly positively correlated with participant smoking and negatively with their lung function test. These results suggest that these measures are reliable and valid to measure prolonged passive smoke exposure from childhood to adulthood. The fourth study illustrated the effect of exposure to passive smoking across childhood using the previously validated measures on cardiovascular function in adulthood. Greater exposure to passive smoking across childhood from the total number of smokers in the household was associated with an increase in central blood pressure. Worse left ventricular function as measured by global longitudinal strain was associated with greater cumulative years of exposure to passive smoke. The fifth pilot study evaluated the effect of exposure to passive smoking during pregnancy and childhood on cardiovascular function in adulthood. There were significant increases in peripheral diastolic blood pressure and decreases in left ventricular function in children exposed to passive smoke at various time-points of exposure from pregnancy to adulthood. Conclusion: The findings in this thesis suggest that exposure to passive smoking during pregnancy and childhood negatively impacts the health of offspring in childhood and into adulthood. Though exposure to maternal smoking during pregnancy is declining, more work needs to be done to reduce exposure and improve the cardiovascular health of children exposed to this risk factor early in life.

This hermeneutic study explores the experience of well-being of eight new mothers who live in the Blue Mountains of N.S.W. The experiences were analysed to illuminate definitions, meanings and practices which create their well being. This study transcends existing notions of health and motherhood. The author argues that mothers resist the social expectations created by the 'ideology of motherhood' by; defining their well-being, redefining and resisting the notion of being the 'good mother' by creating practices to achieve their well-being. Social support is integral to this. The study is grounded in hermeneutics incorporating the Heideggerian ideas of being-in-the-world, co-constitution and the hermeneutic circle and also the Gadamerian idea of fusion of horizons. A post-structuralist feminist perspective is adopted, incorporating Foucault's ideas on power, knowledge, truth and resistance. Eight definitions of these new mothers' well-being are presented. Implications for nursing practice, education and research are discussed