Quality of Life in first-time parents during pregnancy and postpartum period: A study in the New Families research project

Abstract

Background: The transition to parenthood is characterized by physical, psychological, and social changes in both women and men. During this period, their Quality of Life (QoL), specifically related to physical, psychological, and social domains, is influenced by various factors that can increase or decrease t heir QoL levels. The Norwegian Child Health Services (CHS), primarily managed by Public Health Nurses (PHNs), have a longstanding tradition of providing professional support to new parents through home visits and clinical consultations, focusing on health promotion. In t h e City of Oslo, an early universal home visiting program, New Families (NF), has been developed and integrated into t h e traditional CHS. NF involves home visits starting from the third trimester of pregnancy and may continue until the child reaches t w o years of age, depending on the family's needs. The NF research project is current ly evaluating the impact of NF, and this thesis contributes to the project by exploring QoL during the transition to parenthood. While various instruments are frequently used to measure QoL in this target population, less is known about t h e psychometric properties of these instruments. Research on the Norwegian CHSand the outcomes of its users, including parental QoL levels in t h e transition to parenthood, is rare, leading to a need for more evidence in the field of public health nursing. Aims: The overall aim of this thesis was to explore QoL in first-time parents during t h e transition to parenthood. This involved identifying QoL instruments, examining QoL levels and factors associated with QoL, as well as investigating t h e impact of NF on first-time mothers' QoL. The papers included in this thesis had t h e following research aims. Paper II: The aim was to identify instruments used to measure mothers' and/or fathers' QoL during pregnancy and t h e postpartum period, and to describe their characteristics and psychometric properties. Paper II: The research aims were 1) to determine whether Norwegian pregnant women and male partners differed in QoL levels in the third trimester of pregnancy, 2) to determine whether the relationship between perception of sleep and QoL is moderated by depressive symptoms, when analyzed separately in pregnant women and male partners, and 3) to determine whether selected possible predictive factors were associated with QoL when stratified by level of depressive symptoms, in pregnant women and male partners separately. Paper Ill: The research aims were 1) to evaluate the impact of NFon first-time mothers' QoL by exploring differences between the first-time mothers receiving NF and the first-time mothers receiving follow-up as usual, and 2) to investigate the association between QoL, social support and selected possible predictive factors in the sample of first-time mothers. Methods: The first paper was a scoping review conducted through systematic literature searches in M EDLINE, EMBASE, PsychlNFO, ClNAHL, and HaPI. The psychometric properties were defined and categorized using the consensus-based Standards for the selection of health Measurement INstruments (COSMIN). The studies were screened by two reviewers independently, utilizing customized screening questions to assess eligibility against inclusion criteria. Data were systematically extracted into a predesigned data charting matrix and analyzed descriptively. The second and third paper included data from the NF research project, a prospective non randomized controlled study with parallel group design. CHSin five city districts of Oslo were matched in intervention and control groups, with first-time parents allocated based on the residential area. Data were collected between October 2018 and June 2020 at pregnancy week 28 (Tl: pregnant women=228, male partners=197), six weeks postpartum (T2: first-time mothers=184), and three months postpartum (T3: first-time mothers=167). The World Health Organization Quality of Life Questionnaire brief version (WHOQOL-BREF) assessed QoL, including the domains physical health, psychological, social relationships, and environment. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS), social support with the Perinatal Infant Care Social Support Scale (PICSS), and the perception of sleep (enough/not enough) was assessed with a single item. Background variables were also collected. The second paper employed a cross-sectional study, analyzing data from Tl (baseline) on WHOQOL-BREF, EPDS, perception of sleep, and background variables. Descriptive statistics, moderation analyses, and multivariate linear regression were used in data analysis. The third paper, a prospective non-randomized controlled study with parallel group design, included data from Tl to T3 on WHOQOL-BREF, PICSS, and background variables. Multivariate linear regression models were applied to examine the intervention (NF) impact and assess associations. All data were analyzed in SPSSversion 28, and the level of statistical significance was p < 0.05 Results: In the first paper, 5671 unique studies were identified, with 53 studies found eligible for inclusion. The studies were primarily of Asian origin (49%) and conducted after 2014 (51%). We identified 19 QoL instruments, comprising 12 generic and seven period-specific ones, commonly measuring 7 physical, psychological, and social QoL domains. SF-36, SF-12, and WHOQOL-BREF were the instruments most frequently reported on, while SF-12, WHOQOL-BREF, QOL-GRAV, and PQOL had the most information on psychometric properties. None of the identified instruments were evaluated for all nine psychometric properties recommended by the COSMIN. Internal consistency and structural validity were the most reported psychometric properties. We identified three studies that examined psychometric properties of instruments used on male partners/fathers, with WHOQOL BREF being the only one. In the second paper, significantly lower QoL levels were observed in the physical health and psychological domains of pregnant women compared to male partners and on all QoL domains in pregnant women with, compared to without, depressive symptoms. No moderating effect of depressive symptoms on the relationship between the perception of sleep and QoL domains was found. Among the women without depressive symptoms, perceiving enough sleep was significantly associated with the physical health QoL domain. Among the male partners, perceiving enough sleep was significantly associated with higher QoL across all domains. In the third paper, we found no significant impact of NF on the QoL of first-time mothers at three months postpartum. Consequently, we analyzed the sample as one group in association models of QoL and social support. Emotional support was significantly associated with higher QoL levels in the physical health (B=0.19, 95%CI [0.04 to 0.34]) and social relationships (B=0.40, 95%CI [0.20 to 0.60]) domains. Additionally, significant associations were found between appraisal support and higher QoL levels in the psychological (B=0.34, 95%CI [0.18 to 0.50]) and environment (B=0.33, 95%CI [0.19 to 0.48]) domains. The association model also revealed a significant association between QoL levels in pregnancy and QoL levels postpartum across all QoL domains Conclusion: Overall, the findings of this thesis demonstrate that QoL is a suitable concept and measurement outcome in women and men during the transition to parenthood. Their QoL levels across various domains were influenced differently, with associations observed between QoL domains and depressive symptoms, social support, and perception of sleep. The evidence on psychometric properties of QoL instruments in this target population is limited, although there is extensive reporting on internal consistency and structural validity. Future validation studies are warranted. The NF home visiting program did not have a significant impact on the QoL of first-time mothers at three months postpartum. However, the quantitative findings are discussed in relation to the component s of NF and its potential benefits. The insights gained from this thesis provide useful knowledge for the professional practice of public health nurses. Paper I: Brekke, M., Berg, R. C., Amro, A., Glavin, K., & Haugland, T. Quality of Life instruments and their psychometric properties fo r use in parents during pregnancy and the post part um period: a systematic scoping review. Health and Quality of Life Outcomes. 2022; 20(1); 107; doi:10.1186/s12955-022-02011-y Paper li: Brekke, M., Amro, A., Småstuen, M. C., Glavin, K., Solberg, B., Øygarden, A. M. U., Sæther, K.M., Haugland, T. Quality of life in Norwegian pregnant women and men with pregnant partners, and association with perception of sleep and depressive symptoms: a cross-sectional study. BMC Pregnancy and Childbirth. 2023; 23(1); 37; doi:10.1186/ s12884-023- 05379-x Paper Ill: Brekke, M., Småstuen, M. C., Glavin, K., Amro, A., Solberg, B., Øygarden, A. M. U., Sæt her, K.M., Haugland, T. The impact of New Families home visiting program on first-time mothers' quality of life and its association with social support: a non-randomized controlled st udy. BMC Public Heath. 2023; 23:2457; 10.1186/ s12889-023-17285-0