Date of Award

11-2021

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Program

Nursing Science

Research Advisor

J. Carolyn Graff, PhD

Committee

Xueyuan Cao, PhD Kendra G. Hotz, PhD Bruce L. Keisling, PhD Amy R. Koehn, PhD Sarah J. Rhoads, PhD

Keywords

Maternal; Maternal-Child Interaction; Social Support; Traumatic Life Events

Abstract

Introduction: Becoming a parent is a very important role and responsibility in people’s lives and knowing the role traumatic life events (TLEs) may play on a mother-child relationship is a very important area to explore. TLEs are known to have adverse effect on individuals; however, little is known regarding the effect of maternal TLEs on maternal-child interaction. Social support has been known to positively affect the overall wellbeing of individuals, but little is known about the effect of social support on mothers who experienced TLEs and interaction with their children thus the need for this study. This study examines the effect of maternal TLEs and social support on maternal-child interaction. The Child Health Assessment Model and the Barnard Model will be used in this study. This study will examine the occurrence and severity of maternal TLEs and levels of social support and their relationship with sociodemographic factors of mothers and their 3-year-olds. It will examine the relationship between maternal TLEs, and maternal-child interaction measured by the NCAST Parent-Child Interaction (PCI) Teaching scale at child age 3 years; maternal social support and maternal-child interaction at child age 3 years; maternal TLEs and social support with maternal-child interaction at child age 3 years.

Method: This study was a secondary analysis of data from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study, a longitudinal cohort study designed to improve the health, development, and well-being of children in Shelby County, Tennessee. Researchers recruited 1503 women in their second trimester of pregnancy. Data were collected at the 2nd and 3rd trimesters, at the child's birth, and from mother-child dyads at different points through child age three years. Nine hundred and eighty-six mother-child dyads were included in this analysis. Data analysis was performed using R version 4.0.3 (2020-10-10). The CANDLE Study Publications and Presentations Committee approved a Manuscript Analysis Plan Proposal prior to conducting this study.

Results: Children and mothers were largely Black/African American (65.2%), and 34.8% were White. TLEs were associated with sociodemographic variables such as age, education, race, marital status, and child sex—with increased TLEs among Black/African American mothers, divorced/separated/widowed mothers, and mothers without college/professional degree, older mothers reported a lower number of ACEs than younger mothers. Mothers of male children reported fewer events associated with fear and helplessness than mothers of female children. Mother Total score and Contingency score were associated with several sociodemographic variables. Mothers with private health insurance for children ages 2- and 3-years had higher PCI Teaching scale scores. Mothers with at least a college degree at enrollment, child age 2, and child age 3 had higher PCI Teaching scale scores than mothers with no college degree. In the univariate analysis, we did not observe a significant association between maternal TLEs in the third trimester and maternal-child interaction at child age 3 years. When both maternal traumatic life events at the third trimester and social support are included, both were significantly associated with maternal-child interaction at child age 3 years. Although the associations between TLEs and PCI Teaching scale scores were non-significant the number of individuals providing social support was associated with PCI Teaching scale scores. More individuals providing social support was associated with increased PCI Teaching scale Mother-child Total (p < 0.0001) and Mother-child Contingency scores (p < 0.0001). Health insurance was associated with PCI Teaching scale scores — having private insurance was associated with increased Child Total scores at ages 2 (p = 0.037 and 3 (p = 0.004) years.

Conclusion: The association between the number of individuals providing social support and mother-child interaction reinforces the need to provide resources such as home visitation programs to mothers and their young children. Each additional person providing social support in the third trimester was associated with increased PCI Teaching scale scores on both the Mother Total scores and Mother-child Total scores. This points to the relationship between support during the third trimester and the long-term outcome related to maternal-child interaction. The lack of association between TLEs and PCI Teaching scale scores before and after controlling for sociodemographic variables may reflect mothers' resilience. The interaction effect between TLEs and social support on maternal child interaction is notable and shows the need for an upstream approach to prevent TLEs since its interaction with social support diminishes the effect of support on maternal-child interaction.

Declaration of Authorship

Declaration of Authorship is included in the supplemental files.

ORCID

http://orcid.org/0000-0001-5828-7153

DOI

10.21007/etd.cghs.2021.0547

Additional Files
2021-018-Madubuonwu-DOA.pdf (189 kB)
Declaration of Authorship
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