Dissertation defense 2012

Michelle Irvin-GrajedaDissertation Defesnse

January 11, 2012

Breastfeeding

Empowerment

Postpartum Depression

•PPD affects 13-19.2% of women who deliver babies (O’Hara & Swain, 1996; Gavin, et al., 2005)

•Following first PPD episode risk increases to 30-50% (American Psychiatric Association, 2000)

•PPD is not always diagnosed

Parenting Efficacy

•Parent feels competent•Increases well being•Minimizes stress•parent-child relationships•child development outcomes

(de Montigny & Lacharite, 2005;Hudson et al.,2001; Gilmore & Cuskelly, 2008; Jones & Prinz, 2005)

BreastfeedingBenefits

• motor development• infant disease• Infant’s immune system • cognitive abilities

(Evidence, 2005)

PPD and Breastfeeding

• Desire to BF decreases• Mother-child relationship

(Hoddinott et al., 2009)

Empowerment

• Focuses on health• Builds on strengths• Builds confidence

Social Support for New Mothers

•Many sources of social support•More important for 1st time mothers•Linked to successful breastfeeding

(Hoddinnott & Phil, 1999; Bosnjak, et al, 2009)

Breastfeeding Support Groups

•United States has low breastfeeding prevalence•Recommended to new mothers•Research is limited

(Ekstrom, et al., 2006; Bosnjak, 2009; Hoddinnott, et al., 2006; Kang, et al., 2007)

Current Study

•Examined whether and how attending BF support groups impacts new mothers•Whether programs that promote the initiation and maintenance of BF prevent symptoms of: • PPD • enhance self-efficacy

Limited research Diverse Sample Larger sample size Examined the association of attendance &

DVs

What it adds

Mothers who attend BF groups longer ◦ higher levels of wellbeing, PSOC, SS and BF

empowerment◦ decrease in depressive sxs

Determine whether empowerment and social support mediate the effect of attendance on DV

Hypotheses

Participants: ◦ 90 participants ◦ Breastfeeding support groups◦ Community resource center

Breastfeeding support group: ◦ Facilitated by professional◦ Process group◦ Additional services available◦ Open membership

Method

Sample◦ Ages, 16-37, 20% were 29◦ Education, 32.2% BA, Some 27.8%, MA 20%◦ Income, 35.6% 50-59k, 15.6% 70-79k, 13.3% 40-

49k◦ Marital status, 36.7% single/never married,

married 62.2%◦ Ethnicity, 52.2% white, 27.8% Hispanic

Method

Measures:◦ The Edinburgh Postnatal Depression Scale

Cronbachs alpha 0.856◦ Parenting Sense of Competency

0.965◦ Psychological General Well Being Index

0.915

Method

Hypothesized Mediators◦ Breastfeeding Empowerment

0.971◦ Breastfeeding Will

0.885◦ Scales of Perceived Social Support

0.963

Method

Attendance Identify number of sessions attended birth date and date first attended

Method

Series of correlation between attendance◦ PPD◦ Self-efficacy◦ Well being◦ Empowerment◦ Social Support (not correlated)

Mediation◦ Baron & Kenny, 1986◦ Control for the effect of attendance

Analyses

Possible confounds tested Attendance and Experience as a mother

◦ In order to rule out, regression equations were conducted

◦ Age of child in months and attendance as predictors for each DV

Analyses

Attendance Attendance controlling for age of child1

PPD -.299** -.302**

BF Empowerment .638** .717**

PSOC .751** .753**

Wellbeing .465** .463**

Zero order correlations and standardized regression coefficients of attendance and outcome variables

1Note. Regression analysis was run entering both days old and attendance ** p < .01

•Attendance was statistically significant predictor of each even when controlling for experience as mothers

Additional confounds tested:◦ Individual characteristics commonly associated

with better functioning. Education Income Marriage Ethnicity

◦ Findings suggest attendance not greater for white, married, more wealthy, and more educated mothers

Results

Mediator

YX

Results: Mediation

a b

c’

A series of steps with 3 regressions were carried out for each mediator and DV pair

Regression analysis was conducted to determine whether attendance had stat sig effect on DV. ◦ Tests total effect (c) of X on Y

Steps for mediation

YX

2nd step, R.A. conducted ◦ To determine whether the intervention has

statistically sig effect on hypothesized mediator, path a.

3rd, R.A. to determine whether hypothesized mediator was statistically sig predictor of DV’s ◦ while controlling for the effect of the attendance,

path b.

Steps for mediation

Mediator

YX

Results: Mediation

a b

c’

4th, if mediator completely mediates the effect of X on Y ◦ the effect controlling for the mediator (path c’)

should become zero When a partial mediation may exist If conditions were met:

◦ at least for partial mediation…◦ sobel test is conducted using an interactive

calculation tool developed by Preacher and Leonardelli

Results: Mediation

Breastfeeding Empowerment

PSOCAttendence

.638**

.751** (.629**)

..191*

Results: Mediation

•BF Empowerment was a significant predictor of PSOC while controlling for attendance

Breastfeeding Will

PPDAttendence

.682**

.299** (-.205)

.402*

Results: Mediation

•BF Will was a significant predictor of PPD while controlling for attendance

Breastfeeding Will

PSOCAttendence

.682**

.751** (.507**)

.358**

Results: Mediation

•BF Will was a significant predictor of PPD while controlling for attendance

Breastfeeding Will

WellbeingAttendence

.682**

.465** (.238)

.333**

Results: Mediation

•BF Will was a significant predictor of Wellbeing while controlling for attendance

Attendance associated with positive outcomes◦ Greater attendance in BSG associated with increase in

parental self-efficacy Social support

◦ Attendance appeared to have no effect on social support in the current study

BF empowerment mediated the effect of attendance on:◦ parental self efficacy ◦ PPD symptoms ◦ parental self-efficacy ◦ well-being

Discussion

◦ Past research only focused on providing information to mothers little on the interaction of mothers.

interactions continue to build on strengths encouraging self help Teach new skills education about infants and their needs

Discussion

Limits in the ability to draw causal inferences

Examine the predictors of BF Will

Limitations/future directions

Thanks

for listeni

ng!