Antenatal preparation for the early parenthood period. Development and feasibility of an evidence-based programme for antenatal parental preparation

Sammanfattning: Parents often feel inadequately prepared for challenges of early parenthood. This thesis aimed to develop an evidence-based programme for antenatal preparation for early parenthood and to test its feasibility. The Medical Research Council’s framework for development and evaluation of complex interventions was used to design the three studies.Interviews were conducted with first-time parents; 18 mothers and 15 fathers, one month postpartum, about their experiences of preparation for parenthood. Phenomenographical analysis showed that access to support in the preparation helped parents gain knowledge and form realistic expectations. This in turn facilitated parents to strengthen their own resources and develop strategies to deal with challenges. A cross-sectional study with questionnaires from 52 antenatal clinics and 108 midwives explored provision and experiences of antenatal parental preparation. Provision differed between clinics, web-based information was unfrequently used and midwives reported lack of skills in group-leadership and pedagogics. Based on findings from these studies, a systematic literature review and theories related to self-efficacy and co-parenting an evidence-based programme for antenatal parental preparation was developed. Feasibility of the programme was pilot-tested in a cluster-randomised controlled trial. Three antenatal clinics with 19 first-time mothers and 14 first-time fathers formed an intervention group (IG) and four antenatal clinics with 20 first-time mothers and 18 first-time fathers the control group (CG). Data were collected with questionnaires from parents and midwives. Retention rates were 73% (IG) and 79% (CG). Significantly fewer mothers in IG than in CG reported lack of content in the programme (p=0.02). Parental self-efficacy increased more for fathers in IG (7.45; 95% CI -18.04 to 32.94) but not for mothers in IG (- 2.30; 95% CI -18.87 to 14.27) compared to counterparts in CG. More mothers in IG (75%) followed their intention to breastfeed exclusively than in CG (46%). Midwives reported sufficient training and supervision and provided the programme according to study protocol.The programme was found to be feasible; to determine the cost-effectiveness a full-scale trial is required.