1. A BRIEF GROUP ANTENATAL
INTERVENTION TO PROMOTE
HEALTH, HAPPINESS AND HARMONY
IN TRANSITION TO PARENTHOOD
Sharron S. K. Leung1, R. P. Y. Cheng2, F. L. Y. Ip2,
A. C. M. Ngan1, D. O. L. Lee1, K. K. P. Tso2
1The School of Nursing, The University of Hong Kong
2FamilyHealth Service, Department of Health, Hong Kong,
Hong Kong Special Administrative Region of China
This project is one of the intervention projects of FAMILY: A Jockey Club Initiative for a Harmonious Society, funded by The Hong Kong Jockey Club Charities Trust.
2. ACKNOWLEDGMENT
This project is one of the intervention projects of
FAMILY: A Jockey Club Initiative for a Harmonious
Society,
funded by The Hong Kong Jockey Club Charities
Trust.
Prof. T. H. Lam, Director of School of
Public Health, for the guidance who
is the overall Principal Investigator
the FAMILY project.
Prof. Sunita Stewart for her advice
on the project.
Dr. Shirley Leung from Department
of Health, MCHC nurse-in-charge
and all participants
5. Outline of the presentation –
Share the Care Share the Joy
Background
Objectives
Method & Measurements
Pilot study – Need Assessment
Intervention design
Knowledge base and strength of the design
Challenges of implementation and evaluation
Quality assurance
Key features
Participants’ Feedbacks
Findings of RCT are presented in a poster
6. BACKGROUND
Transition point: A new life born into a family
requires new adjustments.
Premises
Inter-generational family relationships are
cherished in Chinese & relevant to modern
families and will enhance long term health,
happiness and harmony.
Awareness of the threats and their long-term
consequences, planning strategies to avoid
them, and practice with basic communication
skills enhances the likelihood that the family
will adjust optimally.
7. BACKGROUND
Vulnerabilities
With the birth of a child, there are shifts in
family relationships and new roles for parents
and grandparents. This is a time of
vulnerabilities but also opportunities to
strengthen family relationships.
Conflict between grandparental generation and
parental generation regarding the roles and
responsibility of care of the baby.
Planning for the immediate post-natal period,
and communication skills can minimize
disharmony.
8. NEED ASSESSMENT
A series of discussion groups have been conducted
Pregnant women and their husbands:
to report their anticipated conflict and disturbance of
relationship due to the demand of childcare.
Postpartum women, their husbands, their parents
and parents-in-law:
to report on their actual causes of disturbance to family
relationships after the birth of the newborn and
the protective factors for those who have minimal
disturbances in family relationship.
9. NEED ASSESSMENT--FINDINGS
Pregnant women and their husbands:
Pregnant women often have difficulty in confirming or
expressing their needs to in-law
do not anticipate having big problems after delivery.
felt difficult to plan ahead.
Postpartum women, their husbands, their parents
and parents-in-law:
did not anticipate any problems before delivery but
were caught up by unexpected difficulties after
delivery.
conflicts within the family were also reported to
increase, particularly with in-law.
conflicts were mainly around the different childcare
beliefs and practices between the two generations.
preferred not to live with in-law if situation allowed.
10. AIM
Using a brief intervention programme
with cognitive dissonance approach to
promote health, happiness and
harmony in families with pregnant
women by enhancing
intergenerational relationships
11. OBJECTIVES
Primary Objectives
To test the effectiveness of the intervention in
improving self-efficacy of first or second-time mothers
in managing conflicts with their in-law (or maternal
mothers).
To enhance intergenerational relationship by
promoting better communication and conflict
management skills.
Secondary Objective
To increase satisfaction of family functioning by developing
better communication and conflict management skills.
To upkeep the mental health status of new mothers in
terms of their perceived stress level and presentation of
depressive symptoms.
12. UNDERLYING VALUES AND PRINCIPLES
Participants were resourceful.
They are primary source in finding answers and
solutions for the problem.
(Cunningham 2006)
13. KNOWLEDGE BASE
Cognitive dissonance approach
(Festinger, 1957, Festinger & Carlsmith, 1959)
Motivation to change is usually low in the
absence of a problem
Aroused state of psychological discomfort and
motivated participants to change when they
experienced discrepancies between attitudes and
behaviors (Using attributional questions)
increase participants’ discrepancies while
minimizing the resistance to chance the
behaviors
(Cunningham 2006)
14. STUDY DESIGN
Research design: RCT with two arms
Arm A: a 4-session intervention
Arm B: Control group with usual antenatal care.
Assessment Time:
before the intervention (T1),
at the end of the intervention (T2), and
6-8 weeks after delivery (T3)
District:
Maternal and Child Health Centres (MCHCs) of the
Department of Health from 4 regions in Hong Kong
15. PARTICIPANTS
Recruited from antenatal clinics of Maternal
& Child Health Centers
Inclusion criteria:
Pregnant women, 14-30 weeks gestation;
First or second time mothers living with husband
Aged 18 years old or above;
Hong Kong resident; Chinese and can communicate in written
Chinese and Cantonese;
Having at least a parent or parent-in-law living in Hong Kong
Exclusion criteria:
Those who will not stay in Hong Kong after childbirth or the
newborn will be taken care by someone outside Hong Kong
Those diagnosed with mental illness or have past history of
mental illness or requiring medication for mental illness
16. FAMILY:
Share the Care, Share the Joy
Workbook
Promotion
Posters
Rolling text in Baby Kingdom website
Recruitment video
showed in MCHC
centers:
Banner
16
18. MEASUREMENTS
Primary Objectives:
Relationship Efficacy Measure-12 items (Bradbury, 1989)
The Stryker Adjustment Checklist-10 items (Stryker, 1955)
Rahim Organizational Conflict Inventory-II-35 items
(Rahim, 1983)
Secondary Objectives:
Family APGAR-5 items (Smikstein et al., 1982)
Short-Form 12 version 2-2 items (SF-12v2) (Ware, 2002)
Subjective Happiness Scale-4 items (Lyubomirsky & Lepper, 1999)
Family Harmony Scale-8 items (a COHORT team of the Family Project)
Perceived Stress Scale-4 items (Cohen et al., 1983)
Edinburgh Postnatal Depression Scale-10 items (Cox et al., 1987)
19. GROUP PARTICIPATORY MODEL
Strategies from Cunningham’s Community Parent
Education (COPE)
(Cunningham 2006)
Show videotaped vignettes
Exaggerated errors of communication
Participants identify errors
Ask attributional questions (cognitive dissonance)
discuss the consequences
Develop alternative strategies & formulate
supporting rationales
Interventionists model solutions
Dyads rehearse strategies in role-play
Practice as homework
20. Features that Enable Success
Attributional questions
Helped to link the communicative behaviors to the
impact on the children and the family relationships.
Participants identified the benefits of having the
grandparents’ help and the long-term positive impact
on the child
Participants were stimulated to identify negative
consequences of errors and the advantages of the
alternatives.
They then anticipated the long-term impact on the
child if the ineffective communications and poor
family relationships were maintained.
21. STRENGTHS
Break down complex interaction
Develop strategies step-by-step
Explore positive & negative consequences
Anticipate the long term impact
Link the behaviors to the impact on the children &
the family relationships
Formulate strategies & supporting rationales
Promote sense of accomplishment & commitment
Coping modeling & problem solving
Elicit positive group process, less resistance
22. INTERVENTION OUTLINE
Session 1
Motivate pregnant women.
anticipate the risk of conflicts and poor
communications
to achieve a better relationship with their in-
law(s) through reflecting attitude and skills of
relationship-building.
Session 2
Introduce emotional control.
verbalize the determination of managing their
negative emotions in their interaction with the
in-law ;
generate strategies to express feelings
effectively and to manage their own emotion.
23. INTERVENTION OUTLINE –Arm A
Session 3
Discuss communication and planning skills.
identify the errors in poor communication and
the consequences of poor communications;
generate a list of barriers to action plan and
coping strategies.
Session 4
Practice effective listening, negotiation & problem
solving skills.
express their concerns in non-threatening way
and to invite feedback in a non-threatening way;
demonstrate skills in brainstorming solutions
and to reach agreed decision.
25. Quality assurance
Intervention manual
Video-taping of sessions
Fidelity rating
Training of interventionist
Consistency of interventionists
26. Result of RCT
Results presented in poster presentation
Date: Thursday 15 July 2010
Time: 10.30-11.00 am & 2.30-14.00 pm
Place: Poster Area Level -1
Poster Session: Maternal Health & Pregnancy
Title: “A RANDOMIZED CONTROLLED TRIAL
TO TEST THE EFFICACY OF A 4-SESSION
ANTENATAL INTERVENTION TO PROMOTE
HEALTH, HAPPINESS AND HARMONY”
28. PARTICIPANTS’ FEEDBACK
94.7% of the participants reported that they like
or very like this program.
94.7% of the participants think that this program
is useful or very useful.
78.9% of the participants will of certainly will
recommend this program to other pregnant
women.
30. CONCLUSION
Well-received by participants
Positive feedback
RCT findings showed significantly improve
conflict management styles, self-efficacy in
relationship building, and family functioning
31. REFERENCE
Cunningham, C. E. (2006). Large group, community-
based, family-centered parenting training. In R.
Barkley. Deficit Hyperactivity Disorder. A Handbook for
Diagnosis and Treatment (3rd Ed.) The Guilford Press.
Festinger, L. & Carlsmith, J. M. (1959). Cognitive
consequences of forced compliance. Journal of Abnormal
and Social Psychology, 56(2), 276-278.
Festinger, L. (1957). A theory of cognitive dissonance.
Stanford, CA: Standford University Press.
