PARENTS’ POSTNATAL SENSE OF SECURITY (PPSS)- developing an instrument and description of important factors based on mothers’ and fathers’ experiences

Sammanfattning: The overall aim of this thesis was to develop and evaluate a specific instrument, measuring both mothers’ and fathers’ postnatal sense of security during the first postnatal week, and to explore and describe important factors associated with this. Data was collected from 2003 to 2009. The thesis has a methodological (Paper I), an evaluative (Paper II) and an explorative and descriptive design (Paper III and IV). In Papers I and II, 113 mothers and 99 fathers took part. Their infants had been born live at term, at one of the five hospitals in southern Sweden. In Papers III and IV, 14 mothers and 13 fathers from two hospital areas, encompassing five different postnatal wards in Southern Sweden, were interviewed. Statistical analysis of the instrument, testing for construct validity with explorative factor analysis, internal consistency reliability and concurrent validity, using a specific item about experienced sense of security (Paper I) and Mann-Whitney U-test, multiple linear regression analysis as well as multiple logistic regression analysis (Paper II), was carried out. The Parents’ Postnatal Sense of Security (PPSS) instrument developed in Paper I was used for evaluation in Paper II. In Paper III and Paper IV the transcribed texts were analysed using qualitative content text analysis. The PPSS instrument, mother’s version, was reduced to 18 items (explained variance 66.8%, Cronbach’s coefficient alpha 0.88) comprising of the following dimensions; a sense of the midwife’s empowering behaviour, a sense of general wellbeing, a sense of affinity within the family and a sense that breast feeding was manageable. The father’s version was reduced to 13 items (explained variance 69%, Cronbach’s coefficient alpha 0.77) and comprising of the following dimensions; a sense of the midwife’s empowering behaviour, a sense of the mother’s general wellbeing including breast feeding, a sense of general wellbeing and a sense of affinity within the family (Paper I). In Paper II a sense of the midwife’s empowering behaviour, a sense of ones own general wellbeing and a sense of the mother’s wellbeing, as experienced by the father, were significantly associated with a single item about experienced sense of security. Besides general anxiety, measured by the STAI-trait instrument, and parity, a sense of participation during pregnancy was a significantly associated background variable for postnatal sense of security, for both parents. For the mothers, a sense that the father was participating was also significant (Paper II). Paper III showed that postnatal sense of security for mothers included the following on eight categories; Being met as an individual, Being given relevant information, Being prepared for the time after birth, Having someone to turn to – knowing who to ask, Having partner and/or significant others close at hand, Mother’s and the baby’s own resources, Being assured that her one physical health was good and Having planned follow-ups after discharge. For fathers (Paper IV) “Participation in the process of childbirth” emerged as a main category and included the following six categories; Willingness to participate and take responsibility, Being given the opportunity to take responsibility, Mother’s and baby’s wellbeing, Having someone to turn to – knowing who to ask, Being met as an individual and Experiencing competent staff. The newly developed PPSS instrument is a valid and reliable instrument and the only specific postnatal instrument measuring both parents’ postnatal sense of security. However it needs to be tested further when the new items are amalgamated (Paper III and IV). Midwives empowering support during the childbirth process, as well as the father’s participation and involvement are important factors beneficial, for both parents’ postnatal sense of security. An empowering organization must give fathers the opportunity to stay overnight at hospital and offer staff availability as well as planned follow-ups of both mother and child.