Introduction Valid and feasible measures are needed of influences on mental health of postpartum women. We tested reliability and validity of the Sources of Stress-Short Form (SoS-SF) and Postpartum Coping Scales-Short Form (PCS-SF). Methods The alpha statistic estimated reliability and correlations with established stress and coping scales estimated validity. Results The SoS-SF subscales were significantly correlated with the established stress scale (Spearman correlations of 0.57 to 0.28). The PCS-SF subscales were significantly correlated with the established coping scale (Spearman correlations of 0.72 to 0.18). Conclusion The SoS-SF and PCS-SF are reasonably reliable and valid scales for use in mental health.

OBJECTIVE:To examine the frequency of unfair treatment based on gender in various contexts, descriptive experiences of it, and its association with postpartum health. DESIGN:Cross-sectional survey with closed- and open-ended responses. SETTING:Online research panel in the United States. PARTICIPANTS:Participants included 86 survey respondents who were 6 to 30 months postpartum. Respondents' mean age was 32.6 years (SD = 5.5 years); 98.8% identified as women; and 69% were White and 31% were Black, Hispanic, or other racial/ethnic identities. METHODS:Survey items included demographic characteristics, the frequency of unfair treatment, contexts in which such treatment occurred (e.g., workplace, health care, relationships), ratings of physical and mental health, and respondents' open-ended descriptions of unfair treatment experiences. Analyses included descriptive and inferential statistics and content analysis. RESULTS:The highest ranked context of unfair treatment based on gender or having young children was the workplace, for example, being denied work opportunities and being judged as less competent based on gender. Although some partners held rigid gendered attitudes, it was unfair treatment in the context of the family (e.g., sexist treatment) or health care visits (e.g., dismissal of symptoms) that were associated with poorer health ratings (p < .01). Friendships was a context where respondents reported exclusion because of having young children. CONCLUSION:Unfair treatment occurred in a wide range of postpartum contexts, and in some contexts, such as health care visits, it was associated with poorer mental and physical health. The findings support the importance of fostering a culture of respectful postpartum care and of linking those who face support challenges to additional resources.

BACKGROUND:Postpartum health-related problems are diverse, and some may extend beyond the first postpartum year. The purpose of this study was to describe women's postpartum health problems in the first and second postpartum years. METHODS:We analyzed data from an online survey (N = 427) conducted in 2024. Respondents gave birth within the past 2 to 22 months. Open-ended questions elicited women's health problems; physical and mental health ratings were also gathered. Data were analyzed by qualitative content analysis and non-parametric statistics. RESULTS:The three most frequently reported problems were depression/anxiety, musculoskeletal issues, and genitourinary disorders. The number of physical health problems did not differ between women 2-12 months and 13-22 months postpartum, p = 0.958. Similarly, mental health problems showed no difference between the time frames, p = 0.087. The number of physical and mental health problems was correlated with each other (r = 0.156, p < 0.01). The number of physical health problems was correlated with body mass index (r = 0.136, p < 0.01) and negatively correlated with physical (r = -0.218, p < 0.01) and mental health ratings (r = -0.175, p < 0.01). The number of mental health problems was negatively correlated with physical (r = -0.202, p < 0.01) and mental health ratings (r = -0.310, p < 0.01). DISCUSSION:Women reported a broad range of postpartum health problems, with no significant differences between the first and second years. Findings underscore postpartum care should be extended into the second year.

OBJECTIVE:To estimate the frequency of racial/ethnic and gender discrimination and lack of a regular source of care in the postpartum period and to examine how these factors were related to health and stress in the postpartum period. DESIGN:Cross-sectional survey study. SETTING:Online research panels in the United States. PARTICIPANTS:Survey respondents (N = 427: 424 women, 1 transgender man, 1 non-binary individual, and 1 individual for whom gender was missing). METHODS:Equity items included racial/ethnic discrimination, gender discrimination, and lack of a regular care source. Health outcomes included a global measure of physical and mental health, perceived stress, and postpartum-specific stress. We analyzed the data using correlational and hierarchical regression analyses adjusted for covariates. RESULTS:Racial/ethnic discrimination was reported by 15.2% of respondents, gender discrimination was reported by 45.9% of respondents, and lack of a regular source of care was reported by 13.8% of respondents. After adjusting for covariates, equity factors accounted for 1.8% of the variance in physical health (p < .05), 3.4% in mental health (p = .001), 5.0% in perceived stress (p < .001), and 7.8% in postpartum-specific stress (p < .001). The only significant equity factor significantly associated with physical and mental outcomes was gender discrimination. CONCLUSION:Nearly half of respondents reported that they experienced gender discrimination. Gender discrimination was significantly related to worse health and higher stress. Nurses can aid women in dealing with gender discrimination by providing information about rights and resources.

We examined the stressors of mothers between 2 and 22 months postpartum, the association of stressors with social factors, and when stressors were heightened. Surveys of 372 women covered social factors and postpartum stressors (Overload, Changes after pregnancy, Baby care, Working mother concerns, Low support, and Isolation). Overload was the most frequent stressor compared to the other stressors, p < .001. Full-time employment and number of children were the social factors most frequently associated with stressors. Overall, social factors were most highly associated with Working mother concerns. Findings indicate that full-time employed mothers could benefit from workplace and community support. In particular, guidance from health care professionals and childbirth educators about managing stress could aid mothers, especially those with first children.

The vast amount of online health resources accessible to the public and the pregnant population shows their high interest in using online health resources for their pregnancies. In this study, we specifically aimed to understand the experience and use of online pregnancy health information among Hispanic individuals, who are at higher risk of gaining outside of the recommended guideline of gestational weight gain (GWG) than the overall U.S. childbearing population. We conducted face-to-face semi-structured interviews with 20 childbearing-age Hispanic individuals (who were either pregnant or non-pregnant) in the Austin area to explore seeking, understanding, and using online information about recommendations for GWG, diet, and physical activity during pregnancy. Using reflexive thematic analysis, we identified both user perspectives and website features that affected the participants’ engagement with and application of online pregnancy information. We conclude that the benefits of online resources fill gaps left by healthcare providers. Nurses as care providers and content creators of health information can help translate guidelines into behaviors that Hispanic people could apply in their everyday lives.

IntroductionA critical gap exists in understanding stressors and coping that affect women's health beyond 6 weeks postpartum. Using new stressor and coping scales tailored to postpartum women, we examined the relationship of postpartum‐specific stressors and coping to women's physical and mental health between 2 to 22 months after childbirth.MethodsA total of 361 women of diverse race, ethnicity, and functional abilities recruited through clinical and online methods completed online surveys that included Sources of Stress‐Revised subscales, such as overload, changes after pregnancy, and low support resources; Postpartum Coping Scale subscales, such as self‐regulation, self‐care, and health promotion; Patient‐Reported Outcomes Measurement Information System Global Health, covering physical and mental health dimensions; and social demographic items. Analyses included hierarchical linear regression models adjusted for social factors.ResultsEducation and employment were the only social factors associated with physical and mental health, respectively. After adjusting for social factors, overload (P < .001) and coping through health promotion (P = .020) were the only additional variables associated with physical health. After adjusting for social factors, overload (P < .001) and low support resources (P = .002) and coping through self‐care (P = .036) were the only additional variables associated with mental health. Thus, being overloaded was the key stressor associated with decreases in physical and mental health. Health promotion was associated with increases in physical health, and self‐care was associated with increases in mental health.DiscussionThese findings point to directions for health care and community interventions to promote health for postpartum women under stress. Strengths of our study include application of stress and coping scales tailored to postpartum women, whereas a limitation is use of a cross‐sectional design.

The current scoping review describes qualitative research on self-transcendence (ST) in older adults. Articles from five databases were independently screened and data were extracted from predetermined categories. Results were compared and consensus reached through discussion. The two leading theorists guiding the chosen studies were Pamela Reed and Lars Tornstam. Experiential language in the studies most often touched on intrapersonal and interpersonal ST. Two main gaps identified in the literature were: (a) limited coverage of transpersonal aspects of ST, and (b) limited inclusion of experiential language of study participants. More qualitative research, phenomenology in particular, can shed light on the topic of ST. A deeper understanding of all aspects of ST, including experiential language used to describe it, can lay a foundation for nursing to advance with theory formation, scale construction, and interventions to better promote spiritual and psychological well-being in older adults. [Journal of Gerontological Nursing, 49(9), 43-48.].

Background Online surveys have proven to be an efficient method to gather health information in studies of various populations, but these are accompanied by threats to data integrity and quality. We draw on our experience with a nefarious intrusion into an online survey and our efforts to protect data integrity and quality in a subsequent online survey. Objectives We aim to share lessons learned regarding detecting and preventing threats to online survey data integrity and quality. Methods We examined data from two online surveys we conducted, as well as findings of others reported in the literature, to delineate threats to and prevention strategies for online health surveys. Results Our first survey was launched inadvertently without available security features engaged in Qualtrics, resulting in a number of threats to data integrity and quality. These threats included multiple submissions, often within seconds of each other, from the same internet protocol (IP) address; use of proxy servers or virtual private networks, often with suspicious or abusive IP address ratings and geolocations outside the United States; and incoherent text data or otherwise suspicious responses. After excluding fraudulent, suspicious, or ineligible cases, as well as cases that terminated before submitting data, 102 of 224 (45.5%) eligible survey respondents remained with partial or complete data. In a second online survey with security features in Qualtrics engaged, no IP addresses were associated with any duplicate submissions. To further protect data integrity and quality, we added items to detect inattentive or fraudulent respondents and applied a risk scoring system in which 23 survey respondents were high risk, 16 were moderate risk, and 289 of 464 (62.3%) were low or no risk and therefore considered eligible respondents. Discussion Technological safeguards, such as blocking repeat IP addresses and study design features to detect inattentive or fraudulent respondents, are strategies to support data integrity and quality in online survey research. For online data collection to make meaningful contributions to nursing research, it is important for nursing scientists to implement technological, study design, and methodological safeguards to protect data integrity and quality and for future research to focus on advancing data protection methodologies.

Objective: To modify and psychometrically assess two scales that are used to measure stress and coping during the extended postpartum period. Design: Instrument modification and psychometric assessment. Setting: Online, community, and health care settings. Participants: Mothers with infants who were 2 to 22 months old: 20 in Phase 1 and 373 in Phase 2. Methods: In Phase 1, participants from diverse backgrounds served as content experts to recommend modifications of items on two scales: Sources of Stress-Revised (SoS-R) and Postpartum Coping Scale (PCS). The results were 32-item modified versions of each scale. In Phase 2, we conducted a psychometric analysis of both revised scales using principal components analysis to identify dimensionality, Cronbach's alphas to estimate internal consistency reliability, and Pearson correlations to estimate validity of the SoS-R and PCS with the Perceived Stress Scale and the Brief COPE, respectively. Results: We identified six components for the SoS-R: Overload, Changes After Pregnancy, Baby-Related Concerns, Working Mother Concerns, Low Support Resources, and Isolated Motherhood. The Cronbach's alpha for the SoS-R was .94. The SoS-R subscales demonstrated correlations with the Perceived Stress Scale that ranged from 0.55 to 0.30. We identified six components for the PCS: Self-Regulation, Spiritual Care, Self-Care, Use and Seek Support, Internal and External Resources, and Health Promotion. The Cronbach's alpha coefficients for the PCS ranged from .84 to .66. The highest correlations observed between the PCS subscales and the Brief COPE subscales ranged from 0.67 to 0.26. Conclusion: The SoS-R and PCS each include six components. Internal consistency reliability for all SoS-R sub-scales and four of six PCS subscales exceeded .70. The dimensions of each scale highlight areas of clinical and research concern.

Background: Neonatal mortality (death within 0-28 d of life) in Kenya is high despite strong evidence that newborn care recommendations save lives. In public healthcare facilities, nurses counsel caregivers on term newborn care, but knowledge about the content and quality of nurses' recommendations is limited. Purpose: To describe the term newborn care recommendations provided at a tertiary-level, public referral hospital in Western Kenya, how they were provided, and related content taught at a university nursing school. Methods: A rapid, focused ethnographic assessment, guided by the culture care theory, using stratified purposive sampling yielded 240 hours of participant observation, 24 interviews, 34 relevant documents, and 268 pages of field notes. Data were organized using NVivo software and key findings identified using applied thematic analysis. Results: Themes reflect recommendations for exclusive breastfeeding, warmth, cord care, follow-up examinations, and immunizations, which were provided orally in Kiswahili and some on a written English discharge summary. Select danger sign recommendations were also provided orally, if needed. Some recommendations conflicted with other providers' guidance. More recommendations for maternal care were provided than for newborn care. Implications for Practice: There is need for improved consistency in content and provision of recommendations before discharge. Findings should be used to inform teaching, clinical, and administrative processes to address practice competency and improve nursing care quality. Implications for Research: Larger studies are needed to determine whether evidence-based recommendations are provided consistently across facilities and other populations, such as community-born and premature newborns, who also experience high rates of neonatal mortality in Kenya.

OBJECTIVE:To systematically review the scope and development of frameworks to promote health during the postpartum period. DATA SOURCES:We searched PubMed, CINAHL, and American Psychological Association PsycInfo during May 2021. STUDY SELECTION:We included English-language, peer-reviewed articles focused on frameworks for health promotion in the postpartum period. We placed no time limit on publication date. Our search resulted in 2,355 articles after we removed duplicates. After excluding articles based on titles and abstracts, we conducted full-text reviews of 23 articles. Three articles met inclusion criteria and addressed the following frameworks: Integrated Perinatal Health Framework, Perinatal Maternal Health Promotion Model, and Maternal Self-Care Framework. DATA EXTRACTION:We extracted data into analytic tables that included categories for the scope, such as time frame, and criteria for the level of development of the frameworks, including the origins, concept definitions and theoretical linkages among concepts, and evidence of application in research or practice. DATA SYNTHESIS:The three frameworks described in the articles included in our review covered various periods, including the reproductive life span, the first year after birth, and the first 6 weeks after birth. Overall, the frameworks were comprehensive. Most key concepts in the frameworks were defined, and some degree of relationships linking concepts was specified. Empirical referents were provided for most but not all concepts in the frameworks. Developers of the three frameworks elaborated on application in practice or health services, but only the developers of the Maternal Self-Care Framework indicated how their framework might be used in research. The Integrated Perinatal Health Framework and Maternal Self-Care Framework were partially derived from existing general theories; the methods used to develop the Perinatal Maternal Health Promotion Model were less clear. CONCLUSION:The frameworks met most criteria and together provided a comprehensive strategy for health promotion during the postpartum period. Elaboration of the frameworks for application in research is needed.

Background: Asian Indians, primarily through immigration, are among the three fastest growing Asian minority populations in the United States. Sadly, Asian Indian Women did not meet the Health People 2020’s the 93% cervical cancer screening goal of 93%. Cervical cancer screening rates among Asian Indian Women were 70.5% compared to 82.7% among non-Hispanic Whites. A systematic review revealed the need for qualitative studies to explore influences of cultural beliefs on cervical cancer screening (pap smears) behaviors among Asian Indian Women applying symbolic interactionism theoretical framework. Purpose: To explore the influence of cultural beliefs on cervical cancer screening behaviors among Asian Indian Women. Method: A qualitative descriptive ethnographic design used descriptive ethosemantic semi-structured questions to investigate cultural impact on cervical cancer prevention behaviors among a purposive sample of 15 Asian Indian Women between the ages 21 to 49 years of age. Data analysis used inductive analytical methods. Findings: Five themes influenced cervical cancer screening: locus of control, concept of health, ‘no sex before marriage,’ awareness, and body image. A healthy internal locus of control, sense of being healthy, awareness, and positive body image supported cervical cancer screening behaviors. An external locus of control, belief that health is not a priority, “no sex before marriage,” and low body image were barriers to cervical cancer screening behaviors. Additionally, the concept of “no sex before marriage” influenced timing of the first pap smear. Notwithstanding their cultural beliefs, employment, health insurance, and recommendations from their providers had a positive impact on cervical cancer screening. Conclusion: Findings from this study have implications for both health policy and clinical practice. Health policy influences funding for basic screening and preventive services. Clinical practice implications encompass fostering partnerships within the community to promote prevention programs and cultural sensitivity training for providers. Future community-based participatory research should address interventional studies to increase compliance for cervical cancer screening and prevention behaviors among Asian Indian Women.

Background: Despite recent emphasis on the "fourth trimester" and beyond, most knowledge of stressors affecting women is focused on the first 6 postpartum weeks. Our aim was to identify postpartum-specific stressors and coping over the extended postpartum period. Methods: We analyzed data from two surveys for a combined sample of 346 postpartum women. Principal components analysis of survey items on sources of stress was used to identify categories of postpartum-specific stressors. Content analysis was used to categorize text data on coping strategies. Results: Seven stressors were identified: Overload, Working mother concerns, Isolated motherhood, Limited supportive resources, Exhaustion, Parenting demands, and Changes in body and sexuality. Overload was the most frequent stressor (F = 49.32, p < 0.001) and was significantly higher at 9-12 months than at 5-8 months or at 13 months or more (F = 6.42, p = 0.002). Fulltime employment and having more than one child were associated with elevated scores on several stressors. Content analysis yielded seven coping strategies, such as Take time alone or with others, Manage emotions and thoughts, and Maintain a manageable workload. Five of the seven stressors were associated with at least one of the top five coping strategies; none was associated with Overload or Limited supportive resources. Conclusions: Women's predominant source of stress was from overload and was highest at 9 to 12 months postpartum. Community resources and public health policy and programming are needed to prepare and support women during the challenging first postpartum year.